Changes in patient selection strategy for radiofrequency ablation of atrial fibrillation in real-world clinical practice

Objective. To analyze changes in clinical-demographic profile of patients referred for radiofrequency ablation (RFA) of atrial fibrillation (AF) and to evaluate the impact of evolving selection criteria on efficacy and safety of interventional procedure. Material and methods. A retrospective comparative analysis was conducted in two cohorts of patients with documented AF who were electively hospitalized for pulmonary vein isolation (PVI): cohort 1 (2016—2018, n=78) and cohort 2 (2021—2022, n=92). Demographic data, arrhythmia duration, comorbidities and characteristics of antiarrhythmic and anticoagulant therapy before admission and at discharge were analyzed. Results. In cohort 2, patients were referred for RFA with significantly shorter history of arrhythmia (59.5 vs. 82.7 months, p<0.001) and less frequently had chronic kidney disease stage 3a (9.8% vs. 21.8%, p<0.05). Changes in pharmacotherapy were observed with complete discontinuation of lappaconitine hydrobromide and amiodarone, reduced prescription of beta-blockers, and improved accuracy of oral anticoagulation (error rate decreased from 18% to 2%, p<0.001). Arrhythmia recurrence rate was significantly lower in cohort 2 (p=0.008). Complications included four cases of intraoperative hemopericardium and one cardioembolic stroke in cohort 1. One case of hemopericardium and one cardioembolic stroke were recorded in Cohort 2. No deaths occurred. Conclusion. Evolution of patient selection criteria combined with optimization of medical management contributes to better efficacy of RFA while maintaining acceptable safety profile. Timely referral for interventional AF treatment is advisable to enhance long-term outcomes and reduce recurrence risk. Early consideration of ablation is recommended for integration into routine clinical practice.