ATRIAL FIBRILLATION ABLATION - THE REAL WOTRLD

Introduction: Atrial fibrillation (AF) became a major health and economic burden. Pulmonary veins isolation (PVI) for rhythm control of AF is well established. Furthermore, recent studies show its superiority over anti-arrhythmic therapy. However, most of these studies were performed in highly experienced centers, that may not reflect real world outcomes.
Methods: We evaluate the outcome (success rate and complications) of 300 consecutive patients (during years 2014-15) of a major HMO that underwent PVI for AF by experienced electrophysiologists in 8 medical centers (85% RF technique). Data were prospectively collected using computerized medical records. Variables included demographic and clinical characteristics, acute procedural success and complications, long term success rate based on multiple ECGs and Holter monitor. The average age was 63 years, 61% were male, 79% had paroxysmal AF. Sinus rhythm at 2 years was considered success.
Results: The overall success rate of maintaining sinus rhythm at 2 years was 54%. Success rate correlated significantly with age and standard risk factors. 61 patients underwent a second ablation with success rate of 64%, 32 underwent a 3rd/4th procedure with success rate of 56%. Thirty five percent of the patients were still on anti-arrhythmic therapy at 2 years post procedure. Complication rate was 6% (2.5% serious), among them 2 deaths, one procedure related.
Conclusions: PVI in a real-world large unselected population is a valid therapeutic option for AF with a 2 year success rate of 54%. In our group higher complication rate was observed compared to the reported rate in the literature. The use of cryo-ablation for PVI may improve both efficacy and safety profile.