Key result
Over a 10-year period, the 1-year single procedure success rate of radiofrequency catheter ablation for atrial fibrillation remained unchanged at approximately 55%, despite shifts toward older patients with more comorbidities and improvements in procedural parameters.
Cohort (n=975)
No
Hazard Ratio: 0.96 (95% CI 0.91–1.02)
Absolute Event Rate: 54.8% vs 55.6%
p-value: p=0.190
Over a decade of AF ablation, patient complexity increased and procedural safety and efficiency improved, but 1-year single-procedure success rates remained unchanged.
AF ablation now targets older, comorbid patients earlier with stable single-procedure success; observational trends leave optimization open for prospective study.
BACKGROUND: Over the past decade, radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) has evolved into a frequently performed procedure. The aim of this study was to monitor changes in patient characteristics, procedural characteristics, outcomes and complications over the past 10 years. METHODS: All consecutive patients who underwent primary RFCA treatment of AF in the University Medical Center Utrecht from 2005-2015 were included. In all patients, the primary ablation strategy was pulmonary vein (PV) antrum isolation without additional substrate modification. Baseline patient and procedure characteristics, and 1‑year follow-up data of 975 patients were prospectively collected. RESULTS: -VASc score ≥2 from 18 to 40.6%. History of AF decreased significantly from 7 to 4 years. Mean procedure duration was 237 ± 53 min in 2005 and 163 ± 41 min in 2014. Fluoroscopy time significantly decreased from 41 ± 17 to 19 ± 8 min and total radiation exposure from 465 (263-687) to 210 (118-376) mGy. One-year success remained similar (2005: 55.6%, 2014: 54.8%), as did the amount of PV reconnection observed during redo procedures. Due to a marked reduction in vascular complications and moderate PV stenosis, the total complication rate decreased significantly. CONCLUSION: Over the past decade, AF ablation has increasingly been performed in older patients with persistent AF and more comorbidity. Moreover, it has been performed earlier after AF diagnosis. Although several performance parameters, such as procedure duration and complication rate, improved, 1‑year single procedure success remained unchanged.
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Teunissen et al. (2017) conducted a cohort in Atrial fibrillation (n=975). Radiofrequency catheter ablation vs. Earlier procedural years (2005 vs 2014) was evaluated on 1-year single procedure success (freedom from atrial tachyarrhythmia recurrence) (HR 0.96, 95% CI 0.91-1.02, p=0.190). Over a 10-year period, the 1-year single procedure success rate of radiofrequency catheter ablation for atrial fibrillation remained unchanged at approximately 55%, despite shifts toward older patients with more comorbidities and improvements in procedural parameters.
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