Spanish catheter ablation registry. 23rd official report of the Heart Rhythm Association of the Spanish Society of Cardiology (2023)

INTRODUCTION AND OBJECTIVES

We report the results of the 2023 Spanish catheter ablation registry.

METHODS

Procedural data were collected and incorporated into the REDCap platform by all participating centers through a specific form.

RESULTS

There were 104 participating centers in 2023 compared with 103 in 2022. In 2023, the total number of ablation procedures was 26 207, indicating a stabilization of the increase observed in 2022 following the pandemic. The increase was mainly due to procedures for atrial fibrillation (AF), with a total of 9942 ablations, representing 38% of all substrates. Notably, pulse-field ablation represented 10.3% of all AF ablation procedures, leading single-shot ablation strategies to outnumber point-by-point AF ablation for the first time in the history of the registry. Cavotricuspid isthmus ablation remained the second most targeted substrate (19% of all substrates, n=5067). The overall acute success rate remained high (97%), with a downward trend in the complication rate (1.6% vs 1.8% in 2022) and mortality rate (0.03%; n=7). Compared with 2022, there was a significant increase in procedures performed using electro-anatomical mapping and zero-fluoroscopy techniques for cavotricuspid isthmus ablation (52% vs 26%), AV node re-entrant tachycardia (48% vs 34%), and accessory pathways (62% vs 22%). We registered 466 ablations in pediatric patients.

CONCLUSIONS

The data indicate a stabilization in the post-pandemic increase in ablation procedures, with an absolute and relative increase in AF as the predominant substrate. Success rates remained stable with a modest reduction in complication and mortality rates.

Spanish catheter ablation registry. 22nd official report of the Heart Rhythm Association of the Spanish Society of Cardiology (2022)

INTRODUCTION AND OBJECTIVES

This article presents results of the Spanish catheter ablation registry for the year 2022.

METHODS

Data were retrospectively entered into a REDCap platform using a specific form.

RESULTS

A total of 103 centers participated (75 public, 28 private), which reported 23 360 ablation procedures, with a mean of 227±173 and a median of 202 [interquartile range, 77-312] procedures per center. Activity significantly increased (+5419 procedures,+30.2%) with more centers participating in the registry (10 more than in 2021). The most common procedure continued to be atrial fibrillation ablation (35%, 8185 procedures) followed by cavotricuspid isthmus ablation (20%, 4640 procedures), and intranodal re-entrant tachycardia (17%, 3898 procedures). There was an increase in all reported substrates, especially atrial fibrillation ablation (+40%), with slightly higher global acute success (96%) and lower complication rates (1.8%) and mortality (0.04%, n=10). In total, 525 procedures were performed in pediatric patients (2.2%) CONCLUSIONS: The Spanish catheter ablation registry systematically and continuously collects the national trajectory, which experienced a significant activity increase in 2022 in all of the reported substrates but especially in atrial fibrillation ablation. Acute success increased, while both complications and mortality decreased.

Spanish catheter ablation registry. 21st official report of the Heart Rhythm Association of the Spanish Society of Cardiology (2021)

INTRODUCTION AND OBJECTIVES

The results of the 2021 Spanish catheter ablation registry are presented.

METHODS

Data collection was carried out retrospectively by filling in and sending a specific form by the participating centers.

RESULTS

Data from 93 centers (65 public, 28 private) were analyzed. A total of 17941 ablation procedures were reported with a mean of 193 ± 133 cases per centre. Recovery of activity from SARS-CoV-2 pandemic lockdown has led to a notable increase in the number of procedures (+2772 procedures, +18%) despite a small decrease in participating centers (4 centers less than in 2020). Atrial fibrillation ablation continues to be the leading procedure, with 5848 procedures (32,6%). Together with ablation of the cavotricuspid isthmus (3766; 21%) and atrioventricular nodal reentrant tachycardia (3132; 17,5%) they constitute the 3 most frequently approached substrates. The total success rate reported (94%) is similar to previous years with a similar rate of complications (2%) and mortality (0.07). A total of 401 procedures were performed in pediatric patients (3,8%).

CONCLUSIONS

The Spanish catheter ablation registry systematically and continuously collects the national activity, which has recovered significantly from the SARS-CoV-2 pandemic impact in 2020. Success rate for 2021 remains high, with a low complication rate.

[Spanish catheter ablation registry. 21st official report of the Heart Rhythm Association of the Spanish Society of Cardiology (2021)]

Introduction and objectives

The results of the 2021 Spanish catheter ablation registry are presented.

Methods

Data collection was carried out retrospectively by filling in and sending a specific form by the participating centers.

Results

Data from 93 centers (65 public, 28 private) were analyzed. A total of 17941 ablation procedures were reported with a mean of 193 ± 133 clases per centre. Recovery of activity from SARS-CoV-2 pandemic lockdown has led to a notable increase in the number of procedures (+2772 procedures, +18%) despite a small decrease in participating centers (4 centers less than in 2020). Atrial fibrillation ablation continues to be the leading procedure, with 5848 procedures (32,6%). Together with ablation of the cavotricuspid isthmus (3766; 21%) and atrioventricular nodal reentrant tachycardia (3132; 17,5%) they constitute the 3 most frequently approached substrates. The total success rate reported (94%) is similar to previous years with a similar rate of complications (2%) and mortality (0.07). A total of 401 procedures were performed in pediatric patients (3,8%).

Conclusions

The Spanish catheter ablation registry systematically and continuously collects the national activity, which has recovered significantly from the SARS-CoV-2 pandemic impact in 2020. Success rate for 2021 remains high, with a low complication rate.

[Spanish Catheter Ablation Registry. 20th Official Report of the Heart Rhythm Association of the Spanish Society of Cardiology (2020)]

INTRODUCTION AND OBJECTIVES

This article reports the results of the 2020 Spanish Catheter Ablation Registry, a year marked by the SARS-CoV-2 pandemic.

METHODS

Data were collected retrospectively through completion and return of a specific form by the participating centers.

RESULTS

Data from 97 centers (67 public, 30 private) were analyzed. A total of 15 169 ablation procedures were reported with a mean of 155 ± 117 and a median [interquartile range] of 115 [62-227]. Because of the SARS-CoV-2 pandemic, both procedures and participating centers markedly decreased (-3380 procedures, -18%) and there were 5 centers less than in 2019. The most common procedure continued to be atrial fibrillation ablation (4513; 30%), well ahead of the remaining substrates, followed by ablation of the cavotricuspid isthmus (3188; 21%), and intranodal re-entry tachycardia (2808; 18%). Ablation of these 3 substrates continued to form the bulk of the procedures. The total success rate was slightly lower than in previous years (88%) with a similar complication rate (n = 309; 2%) and mortality (n = 7; 0.04%). A total of 243 procedures were performed in pediatric patients (1.6%).

CONCLUSIONS

The Spanish Catheter Ablation Registry systematically and continuously reflects the national trajectory, which, in 2020, was markedly affected by the SARS-CoV-2 pandemic. Although slightly lower than in previous years, the success rate remained high, with a low complication rate.Full English text available from:www.revespcardiol.org/en.

Spanish Catheter Ablation Registry. 20th Official Report of the Heart Rhythm Association of the Spanish Society of Cardiology (2020)

INTRODUCTION AND OBJECTIVES

This article reports the results of the 2020 Spanish Catheter Ablation Registry, a year marked by the SARS-CoV-2 pandemic.

METHODS

Data were collected retrospectively through completion and return of a specific form by the participating centers.

RESULTS

Data from 97 centers (67 public, 30 private) were analyzed. A total of 15 169 ablation procedures were reported with a mean of 155±117 and a median [interquartile range] of 115 [62-227]. Because of the SARS-CoV-2 pandemic, both procedures and participating centers markedly decreased (-3380 procedures,-18%) and there were 5 centers less than in 2019. The most common procedure continued to be atrial fibrillation ablation (4513; 30%), well ahead of the remaining substrates, followed by ablation of the cavotricuspid isthmus (3188; 21%), and intranodal re-entry tachycardia (2808; 18%). Ablation of these 3 substrates continued to form the bulk of the procedures. The total success rate was slightly lower than in previous years (88%) with a similar complication rate (n=309; 2%) and mortality (n=7; 0.04%). A total of 243 procedures were performed in pediatric patients (1.6%).

CONCLUSIONS

The Spanish Catheter Ablation Registry systematically and continuously reflects the national trajectory, which, in 2020, was markedly affected by the SARS-CoV-2 pandemic. Although slightly lower than in previous years, the success rate remained high, with a low complication rate.

[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.

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 18549 (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.

Spanish Catheter Ablation Registry. 18th Official Report of the Spanish Society of Cardiology Working Group on Electrophysiology and Arrhythmias (2018)

INTRODUCTION AND OBJECTIVES

This report presents the findings of the 2018 Spanish Catheter Ablation Registry.

METHODS

Data collection was retrospective. A standardized questionnaire was completed by each of the participating centers.

RESULTS

Data sent by 100 centers were analyzed, with a total number of 16566 ablation procedures performed (the highest historically reported in this registry) for a mean of 165.5±127.9 and a median of 119 procedures per center. The ablation targets most frequently treated were atrial fibrillation (n=4234; 25.6%), atrioventricular nodal re-entrant tachycardia (n=3525; 21.3%) and cavotricuspid isthmus (n=3425; 20.7%). A new peak was observed in the ablation of atrial fibrillation, increasing the distance from the other substrates. The overall success rate was 91%. The rate of major complications was 2.2%, and the mortality rate was 0.04%. A total of 2.1% of the ablations were performed in pediatric patients.

CONCLUSIONS

The Spanish Catheter Ablation Registry enrolls systematically and continuously enrolls 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 percentage of complications.

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

INTRODUCTION AND OBJECTIVES

This report describes the findings of the 2017 Spanish Catheter Ablation Registry.

METHODS

Data collection was retrospective. A standardized questionnaire was completed by each of the participating centers.

RESULTS

A total of 15 284 ablation procedures were performed by 98 institutions (the highest number of ablations and institutions historically reported in this registry), with a mean of 156±126 and a median of 136 procedures per center. For the first time, the most frequently treated ablation target was atrial fibrillation (n=3457; 22.6%), followed by cavotricuspid isthmus (n=3449; 22.5%) and atrioventricular nodal re-entrant tachycardia (n=3429; 22.4%). The overall success rate was 87%. The rate of major complications was 2.6%, and the mortality rate was 0.09%. The percentage of procedures performed without fluoroscopic support increased to 6% of all ablations, and 2.3% of all ablations were performed in pediatric patients.

CONCLUSIONS

The Spanish Ablation Catheter Registry systematically and uninterruptedly collects data on the ablation procedures performed in Spain, revealing that both the number of ablations and the number of centers performing them has progressively increased, while maintaining a high success rate and a low percentage of complications.

Spanish Catheter Ablation Registry. 16th Official Report of the Spanish Society of Cardiology Working Group on Electrophysiology and Arrhythmias (2016)

INTRODUCTION AND OBJECTIVES

This report describes the findings of the 2016 Spanish Catheter Ablation Registry.

METHODS

Data were retrospectively collected by means of a standardized questionnaire completed by each of the participating centers.

RESULTS

Data were collected from 83 centers. A total of 13 482 ablation procedures were performed (the highest historically reported in this registry), with a mean of 162.4 ± 116 and a median of 136 procedures per center. The most frequently treated ablation targets were atrioventricular nodal re-entrant tachycardia (n = 3058; 22.7%), atrial fibrillation (n = 2953; 21.9%), and cavotricuspid isthmus (n = 2892; 21.4%). There was a peak in ablation procedures for atrial fibrillation, which, for the first time in this registry, became the second most treated substrate. After exclusion of atrial fibrillation and ventricular tachycardia with underlying heart disease, the overall success rate was 86%. The rate of major complications was 2.3%, and the mortality rate was 0.05%. In all, 2.7% of the ablations were performed in pediatric patients.

CONCLUSIONS

The Spanish Catheter Ablation Registry systematically and uninterruptedly records the ablation procedures performed in Spain, showing a progressive rise in the number of ablations performed, with a high success rate and a low percentage of complications.

Spanish Catheter Ablation Registry. 15th Official Report of the Spanish Society of Cardiology Working Group on Electrophysiology and Arrhythmias (2015)

INTRODUCTION AND OBJECTIVES

This report presents the findings of the 2015 Spanish Catheter Ablation Registry.

METHODS

For data collection, each center was allowed to choose freely between 2 systems: retrospective, requiring the completion of a standardized questionnaire, and prospective, involving reporting to a central database.

RESULTS

Data were collected from 82 centers. A total of 12 863 ablation procedures were performed, for a mean of 157±119 and a median of 138 procedures per center. The ablation target most frequently treated was cavotricuspid isthmus (n=2992 [23.2%]), followed by atrioventricular nodal reentrant tachycardia (n=2966 [23%]) and atrial fibrillation (n=2640 [20.5%]). There were fewer ablation procedures for atrial tachycardia, idiopathic ventricular tachycardia and accessory pathways, while those for ventricular tachycardia in ischemic cardiomyopathy remained steady. The overall success rate, excluding atrial fibrillation and ventricular tachycardia in cardiomyopathy, was 87.5%, the rate of major complications was 2%, and the mortality rate was 0.08%.

CONCLUSIONS

The 2015 registry is the first to show a slight reduction in the number of centers sending in their results and in the total number of ablation procedures performed. The most frequently treated substrate was the cavotricuspid isthmus. There was also a slight decrease in the success rate. The complications and mortality rates remained low.

Spanish Catheter Ablation Registry. 14th Official Report of the Spanish Society of Cardiology Working Group on Electrophysiology and Arrhythmias (2014)

INTRODUCTION AND OBJECTIVES

This report presents the findings of the 2014 Spanish Catheter Ablation Registry.

METHODS

For data collection, each center was allowed to choose freely between 2 systems: retrospective, requiring the completion of a standardized questionnaire, and prospective, involving reporting to a central database.

RESULTS

Data were collected from 85 centers. A total of 12 871 ablation procedures were performed, for a mean of 149.5±103 procedures per center. The ablation targets most frequently treated were atrioventricular nodal reentrant tachycardia (n=3026; 23.5%), cavotricuspid isthmus (n=2833; 22.0%), and atrial fibrillation (n=2498; 19.4%). The number of ablation procedures for ventricular arrhythmias was similar to that of 2013, but there was a slight increase in the treatment of all the ventricular substrates, especially those associated with idiopathic ventricular tachycardia and scarring following myocardial infarction. The overall success rate was 95%, the rate of major complications was 1.3%, and the mortality rate was 0.02%.

CONCLUSIONS

The 2014 registry shows that the number of ablation procedures performed continued its upward trend and that, overall, the success rate was high and the number of complications low. Ablation of complex conditions continued to increase.

Spanish Catheter Ablation Registry. 13th Official Report of the Spanish Society of Cardiology Working Group on Electrophysiology and Arrhythmias (2013)

INTRODUCTION AND OBJECTIVES

This report presents the results of the 2013 Spanish Catheter Ablation Registry.

METHODS

Data were collected using 2 systems: retrospectively by completing a dedicated form and prospectively by reporting to a central database. Each participating center chose 1 of the 2 data collection methods.

RESULTS

Eighty centers voluntarily contributed data to the registry. A total of 11 987 ablation procedures were performed, with a mean (standard deviation) of 149 (105) procedures per center. The 3 main arrhythmic substrates treated were atrioventricular nodal reentrant tachycardia (n=2959; 24.6%), cavotricuspid isthmus ablation (n=2700; 22.5%), and atrial fibrillation (n=2201; 18.4%). The number of ventricular ablation procedures was similar to the 2012 activity, but there was a slight increase in procedures for scar-related postmyocardial infarction ventricular tachycardia. The success rate was 94.4%, major complications occurred in 1.8%, and the mortality rate was 0.03%.

CONCLUSIONS

In line with previous reports, the data from the 2013 registry show a continuing increase in the number of ablations performed. Overall, there was a high success rate and few complications. Ablation of complex substrates has continued to increase.

Spanish Catheter Ablation Registry. 12th Official Report of the Spanish Society of Cardiology Working Group on Electrophysiology and Arrhythmias (2012)

INTRODUCTION AND OBJECTIVES

This article presents the findings of the 2012 Spanish Catheter Ablation Registry.

METHODS

Data were collected in 2 ways: retrospectively using a standardized questionnaire, and prospectively using a central database. Each participating center selected its own preferred method of data collection.

RESULTS

Seventy-four Spanish centers voluntarily contributed data to the survey. A total of 11 042 ablation procedures were analyzed, averaging 149 (103) per center. The 3 main conditions treated were atrioventricular nodal reentrant tachycardia (n=2842; 25.7%), cavotricuspid isthmus (n=2485; 23%), and accessory pathways (n=1999; 18%). Atrial fibrillation was the fourth most common substrate treated (n=1852; 17%), representing a slight increase. The number of ventricular arrhythmia ablation procedures was similar to that of 2011, but there was a decrease in procedures for ventricular tachycardia associated with postinfarction scarring. The overall success rate was 94.9%, major complications occurred in 1.9%, and the overall mortality rate was 0.04%.

CONCLUSIONS

Data from the 2012 registry show that the number of ablations performed continued to increase. Overall, they also show a high success rate and a low number of complications. Ablation of complex substrates continued to increase, particularly in the case of atrial fibrillation.

Spanish Catheter Ablation Registry. 9th Report of the Spanish Society Of Cardiology Working Group on Electrophysiology and Arrhythmias (2009)

INTRODUCTION AND OBJECTIVES

This article reports the findings of the 2009 Spanish national Catheter Ablation Registry.

METHODS

Data were collected in two ways: retrospectively using a standard questionnaire and prospectively from a central database. Each center chose its own preferred method of data collection.

RESULTS

Data were collected from 59 centers. The total number of ablation procedures carried out was 8546, giving a mean of 145 ± 101 procedures per center. The three most frequently treated conditions were atrioventricular nodal reentrant tachycardia (n = 2341; 27%), typical atrial flutter (n = 1859; 21.7%) and accessory pathways (n = 1758; 20.5%). The fourth most common condition was atrial fibrillation (n = 1188; 14%), the number of which has grown by 44% since the 2008 registry. The overall success rate was 93%, major complications occurred in 1.9%, and the mortality rate was 0.046%.

CONCLUSIONS

Data from the 2009 registry show that the number of ablations carried out continued to increase and exceeded 8000 for the first time. In addition, they show, in general, a higher success rate and a lower number of complications. Cavotricuspid isthmus ablation, as treatment for typical atrial flutter, continued to be the second most common procedure. There was a substantial increase in the number of catheter ablations performed for atrial fibrillation compared with previous years.

Atrial tachycardia originating from the pulmonary vein: clinical, electrocardiographic, and differential electrophysiologic characteristics

INTRODUCTION AND OBJECTIVES

Although atrial tachycardia (AT) frequently originates in the pulmonary vein, pulmonary vein atrial tachycardia (PV-AT) can be difficult to recognize on an ECG. The aim of this study was to identify clinical and electrophysiologic characteristics specific to PV-AT, including sinus P-wave duration and notching.

METHODS

The study included 87 patients who underwent AT ablation, divided into four groups: those with PV-AT alone (Group 1, n=25), those with PV-AT associated with atrial fibrillation (Group 2, n=18), and those with other forms of left AT (Group 3, n=7) and right AT (Group 4, n=37).

RESULTS

The mean age of patients in Group 1, at 44 + or - 14 years, was less than in Groups 2, 3 and 4, at 57 + or - 9, 58 + or - 12 and 53 + or - 16 years, respectively (P< .05) and the left atrial diameter, at 38 + or - 4 mm, was less than in the other left AT groups: 48 + or - 7 mm in Group 2 and 49 + or - 5 mm in Group 3 (P< .05). Overall, PV-AT was most frequently due to abnormal automaticity or triggered activity (P< .05) and presented with a short cycle length: 289 + or - 45 ms and 280 + or - 48 ms in Groups 1 and 2, respectively, versus 392 + or - 106 ms and 407 + or - 87 ms in Groups 3 and 4, respectively (P< .05). In patients aged <50 years with AT and no underlying heart disease, PV-AT was significantly (P< .05) associated with a P-wave duration > or = 110 ms (sensitivity 68%, specificity 69%) and P-wave notching (sensitivity 79%, specificity 70%).

CONCLUSIONS

Sinus P-wave prolongation and notching in young patients with a rapid AT but without heart disease predicted an origin in the pulmonary vein.

Spanish Catheter Ablation Registry. 8th official report of the Spanish Society of Cardiology Working Group on Electrophysiology and Arrhythmias (2008)

INTRODUCTION AND OBJECTIVES

This article reports the findings of the 2008 Spanish Catheter Ablation Registry, as compiled by the Spanish Society of Cardiology Working Group on Electrophysiology and Arrhythmias.

METHODS

As in previous years, data were collected in two ways: retrospectively using a standard questionnaire sent to electrophysiology laboratories by the Working Group on Electrophysiology and Arrhythmias, and prospectively from a central database. Each participating center selected its own preferred method of data collection.

RESULTS

Fifty five Spanish centers contributed data voluntarily. In total, 7741 ablations were analyzed, averaging 141+/-97 per center. The three most frequently treated conditions were atrioventricular nodal reentrant tachycardia (n=2302; 31%), typical atrial flutter (n=1720; 22%) and accessory pathways (n=1658; 21%). The fourth most common condition was atrial fibrillation (n=829; 11%), which accounted for 18% more procedures than in 2007. Overall, the success rate was 93%, major complications occurred in 1.7%, and the mortality rate was 0.03%.

CONCLUSIONS

Registry data for 2008 show that the number of ablations carried out continues to increase, and has exceeded 7000 for the second time. In general, the success rate was high and there were few complications. Typical atrial flutter, requiring cavotricuspid isthmus ablation, has become the second most frequently treated condition. A moderate steady increase in the number of ablations for atrial fibrillation was also observed.

Ablation of atrioventricular nodal reentrant tachycardia using remote magnetic guidance (stereotaxis) requires lower temperature and power settings because of improved local contact

INTRODUCTION AND OBJECTIVES

The Stereotaxis(R) remote magnetic navigation system provides a new approach to ablation that could increase catheter stability. The aim was to determine whether improved tissue contact necessitates a change in traditional radiofrequency ablation parameters.

METHODS

The study compared ablation of atrioventricular nodal reentrant tachycardia (AVNRT) using remote navigation (4-mm catheter) in 19 patients with conventional ablation in 18 patients (4-mm catheter, temperature 60-65 degrees C, power 50 W). The radiofrequency energy needed to ensure that no more than a single nodal echo beat could be induced was measured.

RESULTS

Charring was observed with traditional parameters on the first applications of the remotely navigated catheter. Hence, the energy was subsequently reduced (to 50 degrees C and 40 W). There was no difference in the number of applications between remote navigation and conventional groups (median: 6 vs. 8.5; interquartile range [IQR]: 11 vs. 9). Applications lasting <or=5 s were usually due to catheter dislodgment. Only four patients in the remote group had applications <or=5 s compared with 11 in the conventional group (P=.041). Ablation using remote navigation was equally effective and required lower temperatures and powers (mean+/-SD temperature: 46+/-2 degrees C vs. 50+/-4 degrees C, P< .001; median [IQR] power: 29 [14] W vs. 50 [7] W, P< .001), with no difference in total energy delivered. With remote navigation, the range of impedance values between applications was less (mean+/-SD: 10.4+/-7.6 Omega vs. 19.3+/-15.4 Omega; P=.035) and the temperature variation tended to be less, suggesting greater stability between applications. There were no complications.

CONCLUSIONS

In this initial series, remote magnetic navigation was safe and effective in AVNRT ablation. Improved tissue contact reduced catheter dislodgment and necessitated a reduction in radiofrequency energy to avoid charring.

[Update on arrhythmias and cardiac electrophysiology]

This article contains a review of the most important developments in clinical arrhythmology and interventional cardiac electrophysiology that have been reported during the past year. Special emphasis has been placed on clinical conditions that are most prevalent in the general population as well as on progress that has been achieved using the main therapeutic approaches, whether pharmacologic or interventional.

Spanish Catheter Ablation Registry. Seventh official report of the Spanish Society of Cardiology Working Group on Electrophysiology and Arrhythmias (2007)

INTRODUCTION AND OBJECTIVES

This article reports the findings of the 2007 Spanish Catheter Ablation Registry, as compiled by the Spanish Society of Cardiology Working Group on Electrophysiology and Arrhythmias.

METHODS

As in previous years, data were collected in two ways: retrospectively using a standard questionnaire sent to electrophysiology laboratories by the Working Group on Electrophysiology and Arrhythmias, and prospectively from a central database. Each participating center selected its own preferred method of data collection.

RESULTS

Fifty Spanish centers contributed data voluntarily. In total, 7062 ablations were analyzed, averaging 141 (82) per center. The three most frequently treated conditions were atrioventricular nodal reentrant tachycardia (n=2068, 30%), typical atrial flutter (n=1701, 24%) and accessory pathways (n=1624, 23%). A steady increase in both the absolute number of cavotricuspid isthmus ablations for typical atrial flutter and in the relative frequency of this procedure was observed, such that it has overtaken accessory pathway ablation to became the second most common form of treatment. The fourth most common condition was atrial fibrillation (n=659, 9%), which accounted for 22% more procedures than in 2006. Overall, the success rate was 92%, major complications occurred in 1.7%, and the mortality rate was 0.04%.

CONCLUSIONS

Registry data for 2007 show that the number of ablations carried out continues to increase, and has exceeded 7000 for the first time. In general, the success rate was high and there were few complications. Typical atrial flutter, requiring cavotricuspid isthmus ablation, has become the second most frequently treated condition. A moderate steady increase in the number of ablations for atrial fibrillation was also observed.