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Andrade JG. Ablation as First-line Therapy for Atrial Fibrillation. Eur Cardiol 2023; 18:e46. [PMID: 37546183 PMCID: PMC10398511 DOI: 10.15420/ecr.2023.04] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 03/08/2023] [Indexed: 08/08/2023] Open
Abstract
AF is a chronic and progressive heart rhythm disorder characterised by exacerbations and remissions. Contemporary guidelines recommend antiarrhythmic drugs (AADs) as the initial therapy for the maintenance of sinus rhythm. However, these medications have modest efficacy and are associated with significant adverse effects. Several recent trials have evaluated catheter ablation as an initial therapy for AF, demonstrating that cryoballoon catheter ablation significantly improves arrhythmia outcomes (e.g. atrial tachyarrhythmia recurrence and arrhythmia burden), produces clinically meaningful improvements in patient-reported outcomes (e.g. symptoms and quality of life), and significantly decreases healthcare resource usage (e.g. hospitalisation), without increasing the risk of serious adverse events. Moreover, in contrast to antiarrhythmic drugs, catheter ablation appears to be disease-modifying, significantly reducing the progression of disease. These findings are relevant to patients, providers, and healthcare systems, helping inform the initial choice of rhythm-control therapy in patients with treatment-naïve AF.
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Affiliation(s)
- Jason G Andrade
- University of British Columbia Vancouver, Canada
- Centre for Cardiovascular Innovation Vancouver, Canada
- Montreal Heart Institute, Université de Montréal Montreal, Canada
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Qeska D, Singh SM, Qiu F, Manoragavan R, Cheung CC, Ko DT, Sud M, Terricabras M, Wijeysundera HC. Variation and clinical consequences of wait-times for atrial fibrillation ablation: population level study in Ontario, Canada. Europace 2023; 25:euad074. [PMID: 36942997 PMCID: PMC10227764 DOI: 10.1093/europace/euad074] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 02/16/2023] [Indexed: 03/23/2023] Open
Abstract
AIMS Atrial fibrillation (AF) is the most common cardiac rhythm disorder. Emerging evidence supporting the efficacy of catheter ablation in managing AF has led to increased demand for this therapy, potentially outpacing the capacity to perform this procedure. Mismatch between demand and capacity for AF ablation results in wait-times which have not been comprehensively evaluated at a population level. Additionally, the consequences of such delays in AF ablation, namely the risk of hospitalization or adverse events, have not been studied. METHODS AND RESULTS This observational cohort study included adults referred for catheter ablation to treat AF in Ontario, Canada, between 1 April 2016 and 31 March 2020. Wait-time was defined from referral to the earliest of ablation, death, off-list, or the study endpoint of 31 March 2022. The outcomes of interest included a composite of death, hospitalization for AF/heart failure, and emergency department visit for AF/heart failure. Our study cohort included 6253 patients referred for de novo AF ablation. The median wait-time for patients who received and who did not receive ablation was 218 days (IQR: 112-363) and 520 days (IQR: 270-763), respectively. Wait-time increased consistently for patients referred between October 2017 and March 2020. Mortality was rare, but significant morbidity was observed, affecting 19.2% of patients on the waitlist for AF ablation. Paroxysmal AF was associated with a statistically significant greater risk for adverse outcomes on the waitlist (HR 1.51, 95% CI 1.18-1.93). CONCLUSION Wait-times for AF ablation are increasing and are associated with significant morbidity.
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Affiliation(s)
- Denis Qeska
- Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave., Room A202, Toronto, ON M4N 3M5, Canada
- Temerty Faculty of Medicine, University of Toronto, 1 King’s College Circle, Toronto, ON M5S 1A8, Canada
| | - Sheldon M Singh
- Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave., Room A202, Toronto, ON M4N 3M5, Canada
- Temerty Faculty of Medicine, University of Toronto, 1 King’s College Circle, Toronto, ON M5S 1A8, Canada
| | - Feng Qiu
- ICES, 2075 Bayview Ave., Room G1 06, Toronto, ON M4N 3M5, Canada
| | - Ragavie Manoragavan
- Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave., Room A202, Toronto, ON M4N 3M5, Canada
| | - Christopher C Cheung
- Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave., Room A202, Toronto, ON M4N 3M5, Canada
- Temerty Faculty of Medicine, University of Toronto, 1 King’s College Circle, Toronto, ON M5S 1A8, Canada
| | - Dennis T Ko
- Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave., Room A202, Toronto, ON M4N 3M5, Canada
- Temerty Faculty of Medicine, University of Toronto, 1 King’s College Circle, Toronto, ON M5S 1A8, Canada
- ICES, 2075 Bayview Ave., Room G1 06, Toronto, ON M4N 3M5, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St., Toronto, ON M5T 3M6, Canada
| | - Maneesh Sud
- Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave., Room A202, Toronto, ON M4N 3M5, Canada
- Temerty Faculty of Medicine, University of Toronto, 1 King’s College Circle, Toronto, ON M5S 1A8, Canada
- ICES, 2075 Bayview Ave., Room G1 06, Toronto, ON M4N 3M5, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St., Toronto, ON M5T 3M6, Canada
| | - Maria Terricabras
- Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave., Room A202, Toronto, ON M4N 3M5, Canada
- Temerty Faculty of Medicine, University of Toronto, 1 King’s College Circle, Toronto, ON M5S 1A8, Canada
| | - Harindra C Wijeysundera
- Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave., Room A202, Toronto, ON M4N 3M5, Canada
- Temerty Faculty of Medicine, University of Toronto, 1 King’s College Circle, Toronto, ON M5S 1A8, Canada
- ICES, 2075 Bayview Ave., Room G1 06, Toronto, ON M4N 3M5, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St., Toronto, ON M5T 3M6, Canada
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Deyell MW, Hoskin K, Forman J, Laksman ZW, Hawkins NM, Bennett MT, Yeung-Lai-Wah JA, Chakrabarti S, Krahn AD, Andrade JG. Same-day discharge for atrial fibrillation ablation: outcomes and impact of ablation modality. Europace 2022; 25:400-407. [PMID: 36164922 PMCID: PMC9935052 DOI: 10.1093/europace/euac170] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 08/18/2022] [Indexed: 11/12/2022] Open
Abstract
AIMS Same-day discharge is increasingly common after catheter ablation for atrial fibrillation (AF). However, the impact of same-day discharge on healthcare utilization after ablation and whether this differs by ablation modality remains uncertain. We examined the safety, efficacy, and subsequent healthcare utilization of a same-day discharge protocol for AF ablation, including radiofrequency (RF) and cryoballoon ablation, in a contemporary cohort. METHODS AND RESULTS All consecutive patients for whom full healthcare utilization data were available at two centres and who underwent AF ablation from 2018 to 2019 were included. Same-day discharge was the default strategy for all patients. The efficacy and safety outcomes were proportions of same-day discharge and readmission/emergency room (ER) visits, and post-discharge complications, respectively. Of the 421 patients who underwent AF ablation (mean 63.3 ± 10.2 years, 33% female), 90.5% (381/421) achieved same-day discharge with no difference between RF and cryoballoon ablation (89.8 vs. 95.1%, adjusted P = 0.327). Readmission ≤30 days occurred in 4.8%, with ER visits ≤30 days seen in 26.1% with no difference between ablation modalities (P = 0.634). Patients admitted overnight were more likely to present to the ER (40.0 vs. 24.7% with same-day discharge, P = 0.036). The overall post-discharge complication rate was low at 4/421 (1.0%), with no difference between ablation modality (P = 0.324) and admission/same-day discharge (P = 0.485). CONCLUSION Same-day discharge can be achieved in a majority of patients undergoing RF or cryoballoon ablation for AF. Healthcare utilization, particularly ER visits, remains high after AF ablation, regardless of ablation modality or same-day discharge.
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Affiliation(s)
- Marc W Deyell
- Corresponding author. Tel: +1 605 806 8256. E-mail address:
| | - Kurt Hoskin
- Division of Cardiology, Department of Medicine, University of British Columbia, #200-1033 Davie Street, Vancouver, BC, Canada V6E 1M7
| | - Jacqueline Forman
- St. Paul's Hospital, Providence Health Care, 1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6
| | - Zachary W Laksman
- Division of Cardiology, Department of Medicine, University of British Columbia, #200-1033 Davie Street, Vancouver, BC, Canada V6E 1M7,Centre for Cardiovascular Innovation, University of British Columbia, 2775 Laurel Street, 9th Floor, Vancouver, BC, Canada V5Z 1M9
| | - Nathaniel M Hawkins
- Division of Cardiology, Department of Medicine, University of British Columbia, #200-1033 Davie Street, Vancouver, BC, Canada V6E 1M7,Centre for Cardiovascular Innovation, University of British Columbia, 2775 Laurel Street, 9th Floor, Vancouver, BC, Canada V5Z 1M9
| | - Matthew T Bennett
- Division of Cardiology, Department of Medicine, University of British Columbia, #200-1033 Davie Street, Vancouver, BC, Canada V6E 1M7,Centre for Cardiovascular Innovation, University of British Columbia, 2775 Laurel Street, 9th Floor, Vancouver, BC, Canada V5Z 1M9
| | - John A Yeung-Lai-Wah
- Division of Cardiology, Department of Medicine, University of British Columbia, #200-1033 Davie Street, Vancouver, BC, Canada V6E 1M7
| | - Santabhanu Chakrabarti
- Division of Cardiology, Department of Medicine, University of British Columbia, #200-1033 Davie Street, Vancouver, BC, Canada V6E 1M7
| | - Andrew D Krahn
- Division of Cardiology, Department of Medicine, University of British Columbia, #200-1033 Davie Street, Vancouver, BC, Canada V6E 1M7,Centre for Cardiovascular Innovation, University of British Columbia, 2775 Laurel Street, 9th Floor, Vancouver, BC, Canada V5Z 1M9
| | - Jason G Andrade
- Division of Cardiology, Department of Medicine, University of British Columbia, #200-1033 Davie Street, Vancouver, BC, Canada V6E 1M7,Centre for Cardiovascular Innovation, University of British Columbia, 2775 Laurel Street, 9th Floor, Vancouver, BC, Canada V5Z 1M9
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