Spanish Catheter Ablation Registry. 17th Official Report of the Spanish Society of Cardiology Working Group on Electrophysiology and Arrhythmias (2017)

Feasibility and safety of interventional electrophysiology and catheter ablation in the South African public sector: Challenges and opportunities for comprehensive cardiac electrophysiology in South Africa

Aims

The spectrum and outcomes of catheter ablation procedures performed in South Africa are unknown, and therefore, the feasibility of interventional electrophysiology in the South African public sector is undetermined.

Methods and Results

This study was a retrospective review of all patients that underwent invasive electrophysiology procedures and catheter ablation at Groote Schuur Hospital (GSH) and the University of Cape Town Private Academic Hospital (UCTPAH) between 01 January 2013 and 31 December 2020.One thousand one hundred eighty-six invasive electrophysiology procedures were performed during the study period. Of these were 1102 catheter ablation procedures. There were 76 redo catheter ablation procedures, predominantly for atrial fibrillation (AF), which accounted for 39% (30/76) of the repeat procedures. There were only 0.8% (9/1102) catheter ablation related complications which were mostly access related. Atrial fibrillation accounted for most of the ablation procedures, 28.9% (318/1102); these were mainly performed at UCTPAH than at GSH, 300 vs 18 p < .0001. Cavotricuspid isthmus (CTI) dependent atrial flutter ablation was the second most commonly performed catheter ablation procedure, accounting for 21.6% (238/1102) of the catheter ablation procedures. More CTI dependent atrial flutter ablations were performed at GSH than a UCTPAH, 156 vs 82 p < .0001. The overall success rate of catheter ablation was 92%.

Conclusion

A broad spectrum of catheter ablation procedures was performed with a high success rate and limited complications, thus demonstrating the feasibility of safe cardiac electrophysiology and catheter ablation in the South African public sector.

[Spanish Catheter Ablation Registry. 19th Official Report of the Heart Rhythm Association of the Spanish Society of Cardiology (2019)]

INTRODUCTION AND OBJECTIVES

This report presents the findings of the 2019 Spanish Catheter Ablation Registry.

METHODS

Data collection was retrospective. A standardized questionnaire was filled by each of the participant centers.

RESULTS

Data sent by 102 centers were analyzed, with a total number of ablation procedures performed of 18 549 (the highest historically reported in this registry) for a mean of 181.9 ± 137.0 and a median of 144.5 procedures per center. The ablation targets most frequently treated were atrial fibrillation (n = 5164; 27.8%), cavotricuspid isthmus (n = 3925; 21.1%) and atrioventricular nodal reentrant tachycardia (n = 3768; 20.3%). A new peak is observed in the ablation of atrial fibrillation, increasing the distance from the other substrates. The overall success rate was again 91%. The rate of major complications was 1.9%, and the mortality rate was 0.03%. An electroanatomic mapping system was used in 44.5% of all procedures, with contact force-sensing irrigated catheters become the preferred for complex substrates, as atrial fibrillation (84.8%) or ventricular tachycardia (around 90%). 1.5% of the ablations were performed in pediatric patients.

CONCLUSIONS

The Spanish Catheter Ablation Registry enrolls systematically and uninterruptedly the ablation procedures performed in Spain, showing a progressive increasing in the number of ablations over the years with a high success rate and low percentages of complications.

What Have We Learned from the European Society of Cardiology 2019 Guidelines on Supraventricular Tachycardia

Supraventricular tachycardias (SVTs) are common arrhythmic conditions in clinical practice. Increased knowledge and experience on SVTs and some unclear situations in clinical practice led the European Society of Cardiology (ESC) team to write a new guideline. In this review, we touch upon the important points in the new ESC 2019 SVT guidelines and present changing approaches and suggestions. By providing a general review on SVTs, we also mention the basic mechanism, epidemiology, and clinical presentation of SVTs, approaching narrow and wide QRS tachycardias, SVTs in special patient groups, and treatment of SVTs.

Study design of nationwide Japanese Catheter Ablation Registry: Protocol for a prospective, multicenter, open registry

BACKGROUND

Catheter ablation has become a popular interventional treatment for cardiac tachyarrhythmias and the number has been on the rise year by year. However, little is known about its efficacy and safety in the real-world settings.

METHOD

Japanese Catheter Ablation (J-AB) Registry is a nationwide, multicenter, observational registry, performed by Japanese Heart Rhythm Society (JHRS), collaborated with National Cerebral and Cardiovascular Center. This study is a voluntary nationwide registry and data are collected prospectively using a Research Electronic Data Capture (REDCap) system. Detailed data collection including antiarrhythmic medication is also performed every September. The acute success rate at discharge and the complications associated with ablation procedure will be collected in all cases. Major bleeding events are defined according to Bleeding Academic Research Consortium criteria. Based on the provided information, the annual incidence and predictive factors for outcome will be investigated by the Event Assessment Committee. This registry started in August 2017 and the number of participating medical instructions will be more than 250 hospitals and the target procedure number will be 70 000 per year. We will also compare the results with other registries in foreign countries.

RESULT

The results of this study are currently under investigation.

CONCLUSION

The J-AB registry will provide a real-world data regarding the acute success and complications in Japan, focusing on various types of catheter ablation for cardiac arrhythmias.