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Ngo L, Lee XW, Elwashahy M, Arumugam P, Yang IA, Denman R, Haqqani H, Ranasinghe I. Freedom from atrial arrhythmia and other clinical outcomes at 5 years and beyond after catheter ablation of atrial fibrillation: a systematic review and meta-analysis. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2023; 9:447-458. [PMID: 37336617 PMCID: PMC10658515 DOI: 10.1093/ehjqcco/qcad037] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/13/2023] [Accepted: 06/18/2023] [Indexed: 06/21/2023]
Abstract
AIMS Catheter ablation of atrial fibrillation (AF) is now a mainstream procedure although long-term outcomes are uncertain. We performed a systematic review and meta-analysis of procedural outcomes at 5 years and beyond. METHODS AND RESULTS We searched PubMed and Embase and after the screening, identified 73 studies (67 159 patients) reporting freedom from atrial arrhythmia, all-cause death, stroke, and major bleeding at ≥5 years after AF ablation. The pooled mean age was 59.7y, 71.5% male, 62.2% paroxysmal AF, and radiofrequency was used in 78.1% of studies. Pooled incidence of freedom from atrial arrhythmia at 5 years was 50.6% (95%CI 45.5-55.7%) after a single ablation and 69.7% [95%CI (confidence interval) 63.8-75.3%) after multiple procedures. The incidence was higher among patients with paroxysmal compared with non-paroxysmal AF after single (59.7% vs. 33.3%, p = 0.002) and multiple (80.8% vs. 60.6%, p < 0.001) ablations but was comparable between radiofrequency and cryoablation. Pooled incidences of other outcomes were 6.0% (95%CI 3.2-9.7%) for death, 2.4% (95%CI 1.4-3.7%) for stroke, and 1.2% (95%CI 0.8-2.0%) for major bleeding at 5 years. Beyond 5 years, freedom from arrhythmia recurrence remained largely stable (52.3% and 64.7% after single and multiple procedures at 10 years), while the risk of stroke and bleeding increased over time. CONCLUSION Nearly 70% of patients having multiple ablations remained free from atrial arrhythmia at 5 years, with the incidence slightly decreasing beyond this period. Risk of death, stroke, and major bleeding at 5 years were low but increased over time, emphasizing the importance of long-term thromboembolism prevention and bleeding risk management.
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Affiliation(s)
- Linh Ngo
- Greater Brisbane Clinical School, Medical School, The University of Queensland, Chermside, QLD 4032, Australia
- Department of Cardiology, The Prince Charles Hospital, Chermside, QLD 4032, Australia
| | - Xiang Wen Lee
- Greater Brisbane Clinical School, Medical School, The University of Queensland, Chermside, QLD 4032, Australia
- Department of Cardiology, The Prince Charles Hospital, Chermside, QLD 4032, Australia
| | | | - Pooja Arumugam
- Greater Brisbane Clinical School, Medical School, The University of Queensland, Chermside, QLD 4032, Australia
| | - Ian A Yang
- Greater Brisbane Clinical School, Medical School, The University of Queensland, Chermside, QLD 4032, Australia
- Department of Thoracic Medicine, The Prince Charles Hospital, Chermside, QLD 4032, Australia
| | - Russell Denman
- Department of Cardiology, The Prince Charles Hospital, Chermside, QLD 4032, Australia
| | - Haris Haqqani
- Greater Brisbane Clinical School, Medical School, The University of Queensland, Chermside, QLD 4032, Australia
- Department of Cardiology, The Prince Charles Hospital, Chermside, QLD 4032, Australia
| | - Isuru Ranasinghe
- Greater Brisbane Clinical School, Medical School, The University of Queensland, Chermside, QLD 4032, Australia
- Department of Cardiology, The Prince Charles Hospital, Chermside, QLD 4032, Australia
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Ngo L, Ali A, Ganesan A, Woodman R, Adams R, Ranasinghe I. Ten-year trends in mortality and complications following catheter ablation of atrial fibrillation. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2022; 8:398-408. [PMID: 34982824 DOI: 10.1093/ehjqcco/qcab102] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 01/02/2022] [Indexed: 06/14/2023]
Abstract
AIMS Recent US studies report rising rates of mortality and in-hospital complications following catheter ablation of atrial fibrillation (AF), but whether this is a global phenomenon is uncertain. The aim of this study was to examine trends in 30-day mortality and complications following AF ablation in Australia and New Zealand (ANZ) from 2008 to 2017. METHODS AND RESULTS We identified 37 243 AF (mean age 62.4 ± 11.5 years, 29.6% females, 94.5% elective procedures) ablations using national hospitalization data. The primary outcome was occurrence of any complication, including all-cause mortality, within 30 days of discharge. Trends were evaluated using logistic regression adjusting for changes in patient characteristics. The annual number of ablations increased from 1359 (2008) to 5115 (2017). Patients' age and rates of heart failure (9.8-10.6%), diabetes (6.8-12.4%), and chronic kidney disease (2.2-4.1%) also increased over time. From 2008 to 2017, the overall rate of complications declined from 7.51% to 5.04% [adjusted odds ratio (aOR) 0.96 (95% confidence interval, CI, 0.94-0.97)/year]. Rates of pericardial effusion [1.69-0.70%, aOR 0.93 (0.89-0.97)], bleeding [4.49-2.74%, aOR 0.94 (0.92-0.96)], and vascular injury [0.52-0.16%, aOR 0.91 (0.85-0.98)] declined, but rates of acute kidney injury [0.15-0.68%, aOR 1.16 (1.08-1.25)] and infection [0.15-0.57%, aOR 1.07 (1.01-1.14)] increased over time. The overall 30-day mortality rate was low (0.11%) and unchanged [0.00-0.16%, aOR 0.99 (0.88-1.11)]. CONCLUSION Despite a five-fold increase in AF ablations and the rising risk profile of patients, complications following AF ablation declined by 30% from 2008 to 2017 in ANZ. Procedure-related death was uncommon and occurred in less than 1 in 850 patients.
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Affiliation(s)
- Linh Ngo
- School of Clinical Medicine, Faculty of Medicine, the University of Queensland, QLD, Brisbane, Australia
- Department of Cardiology, The Prince Charles Hospital, 627 Rode Road, Chermside, QLD 4032, Brisbane, Australia
- Department of Cardiovascular and Thoracic Surgery, Cardiovascular Centre, E Hospital, Hanoi, Vietnam
| | - Anna Ali
- School of Medicine, Faculty of Health and Medical Sciences, the University of Adelaide, SA, Adelaide, Australia
| | - Anand Ganesan
- Department of Cardiovascular Medicine, Flinders Medical Centre, SA, Australia
- College of Medicine and Public Health, Flinders University, SA, Australia
| | - Richard Woodman
- Flinders Centre for Epidemiology and Biostatistics, College of Medicine and Public Health, Flinders University, SA, Australia
| | - Robert Adams
- College of Medicine and Public Health, Flinders University, SA, Australia
- Respiratory and Sleep Services, Southern Adelaide Local Health Network, SA, Adelaide, Australia
| | - Isuru Ranasinghe
- School of Clinical Medicine, Faculty of Medicine, the University of Queensland, QLD, Brisbane, Australia
- Department of Cardiology, The Prince Charles Hospital, 627 Rode Road, Chermside, QLD 4032, Brisbane, Australia
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Lee E, Park HS, Han S, Nam GB, Choi JI, Pak HN, Oh IY, Shin DG, On YK, Park SW, Kim YH, Oh S, Ahn J, Ahn MS, Baek YS, Cha MJ, Cha TJ, Choi EK, Choi HO, Choi JI, Chun KJ, Gwag HB, Han S, Hwang Y, Hyun DW, Jin ES, Kang KW, Kim DH, Kim DK, Kim D, Kim JH, Kim JB, Kim M, Kim SH, Kim YR, Kim YH, Ko JS, Kwak JJ, Lee E, Lee S, Lee SR, Lee SH, Lee YS, Nam GB, Namgung J, Oh IY, Oh S, Oh YS, On YK, Pak HN, Park HC, Park HS, Park HW, Park SW, Park YM, Park YA, Rhee KS, Shim J, Shin DG, Song IG, Sung JH, Yang PS. Catheter ablation of atrial fibrillation in Korea: results from the Korean Heart Rhythm Society Ablation Registry for Atrial Fibrillation (KARA). INTERNATIONAL JOURNAL OF ARRHYTHMIA 2021. [DOI: 10.1186/s42444-021-00047-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
This study aims to investigate the current status of AF (atrial fibrillation) catheter ablation in Korea.
Methods
The patients who underwent AF catheter ablation from September 2017 to December 2019 were prospectively enrolled from 37 arrhythmia centers. Demographic data, procedural characteristics, the extent of catheter ablation, acute success of the ablation lesion set, rate and independent risk factor for recurrence of AF were analyzed.
Results
A total of 2402 AF patients [paroxysmal AF (PAF) 45.7%, persistent AF (PeAF) 43.1% and redo AF 11.2%] were included. Pulmonary vein isolation (PVI) was performed in 2378 patients (99%) and acute success rate was 97.9%. Additional non-PV ablation (NPVA) were performed in 1648 patients (68.6%). Post-procedural complication rate was 2.2%. One-year AF-free survival rate was 78.6% and the PeAF patients showed poorer survival rate than the ones with other types (PeAF 72.4%, PAF 84.2%, redo AF 80.0%). Additional NPVA did not influence the recurrence of AF in the PAF patients (PVI 17.0% vs. NPVA 14.6%, P value 0.302). However, it showed lower AF recurrence rate in the PeAF patients (PVI 34.9% vs. NPVA 24.4%, P value 0.001). Valvular heart disease, left atrial diameter, PeAF, PVI alone, need of NPVA for terminating AF, and failed ablation were independent predictors of AF recurrence.
Conclusions
Additional NPVA was associated better rhythm outcome in the patients with PeAF, not in the ones with PAF. The independent risk factors for AF recurrence in Korean population were similar to previous studies. Further research is needed to discover optimal AF ablation strategy.
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Kim MH, You SC, Sung JH, Jang E, Yu HT, Kim TH, Pak HN, Lee MH, Yang PS, Joung B. Safety and long-term outcomes of catheter ablation according to sex in patients with atrial fibrillation: A nationwide cohort study. Int J Cardiol 2021; 338:95-101. [PMID: 34147556 DOI: 10.1016/j.ijcard.2021.06.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 06/10/2021] [Accepted: 06/12/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Catheter ablation is more effective than antiarrhythmic drug therapy alone in patients with atrial fibrillation (AF). However, there are limited data on the outcomes of AF ablation according to sex. The purpose of this study was to evaluate gender differences in the actual outcomes after catheter ablation for atrial fibrillation. METHODS Of 801,710 patients with AF in the Korean National Health Insurance Service database, we identified 9175 patients without valvular heart disease who underwent AF ablation between 2006 and 2015 and assessed 30-day safety and one-year effectiveness outcomes according to sex. RESULTS Of the 9175 patients who underwent AF ablation, 2206 (24%) were female. Women, compared to men, were older (60.8 ± 10.2 vs. 56.0 ± 10.5 years), had higher CHA2DS2-VASc (3.5 ± 1.7 vs. 2.0 ± 1.6), higher HAS-BLED (2.6 ± 1.3 vs. 2.4 ± 1.2), and higher Charlson comorbidity index scores (3.8 ± 2.6 vs. 3.1 ± 2.5) (p < 0.001 for all). Following ablation, there was no significant difference in the risk of 30-day complications, including hemorrhage and tamponade, between women and men. In multivariable analyses, there were no significant differences in all-cause hospitalization (adjusted hazard ratio [HR] 1.05, 95% confidence interval [CI] 0.91-1.22, p = 0.489) and AF rehospitalization (adjusted HR 1.16, 95% CI 0.96-1.40, p = 0.135). Women were less likely to undergo cardioversion (adjusted HR 0.72, 95% CI 0.62-0.84, p < 0.001) but were more likely to be re-hospitalized for heart failure (adjusted HR 1.86, 95% CI 1.11-3.11, p = 0.019). CONCLUSION Women who underwent AF ablation did not differ from men in terms of the risk of complications and all-cause hospitalization in this study. The small increased risk in women reported in previous studies may be related to residual confounding, particularly from insufficient control for age and comorbidities.
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Affiliation(s)
- Moon-Hyun Kim
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seng Chan You
- Department of Preventive Medicine and Public Health, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jung-Hoon Sung
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Eunsun Jang
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hee Tae Yu
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Tae-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Moon-Hyoung Lee
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Pil-Sung Yang
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea.
| | - Boyoung Joung
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
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