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Sophia Antipolis, 19 January 2017: More than half of patients with atrial fibrillation (AF) become asymptomatic after catheter ablation, reports the largest study of the procedure published today in European Heart Journal.1
AF is the most common heart rhythm disturbance and incidence is rising. It is estimated that there will be 14 to 17 million patients with AF in the European Union by 2030, with 120 000 to 215 000 new cases diagnosed each year.2
The consequences of AF can be devastating. AF increases the risk of death by two-fold in women and 1.5-fold in men, it causes 20–30% of all strokes, and it reduces quality of life because of palpitations, shortness of breath, tiredness, weakness, and psychological distress.
Catheter ablation is the recommended treatment for AF patients with symptoms who still have an abnormal heart rhythm despite taking antiarrhythmic drugs. During the procedure, a long wire is threaded through the blood vessels into the heart and used to burn or freeze small areas of the atrium. This creates a scar and destroys or fences off abnormal electrical signals to stop them causing AF.
Today’s paper reveals the in-hospital and one-year outcomes and management of 3 630 AF patients treated with catheter ablation in Europe, the Middle East and North Africa. The observational study of real life clinical practice was conducted by the European Heart Rhythm Association (EHRA) of the European Society of Cardiology (ESC) under the EURObservational Research Programme (EORP).
The results show that the typical AF patient who undergoes ablation has symptoms, is around 60 years old, male, has paroxysmal AF (AF that comes and goes), and does not have underlying structural heart disease. In contrast, according to two large European registries, AF patients in the general population tend to be older, more asymptomatic, and have underlying structural heart disease.3–5
Symptoms significantly reduced after ablation, with more than half of patients becoming completely asymptomatic. “This is good news for patients,” said lead author Dr Elena Arbelo, a senior specialist in the Arrhythmia Unit – Cardiovascular Institute, Hospital Clínic de Barcelona, Spain. “According to our registry, 91% of patients choose to undergo an ablation for relief of symptoms and 66% to improve their quality of life.”
After the procedure, patients with two or more stroke risk factors should be prescribed oral anticoagulants, while those with no risk factors should not receive them. But the study found that 27% of patients with two or more risk factors were not anticoagulated, while one-third of low risk patients were receiving the drugs.
“This is a serious issue,” said Dr Arbelo. “High risk patients who do not receive oral anticoagulation have a greater chance of a stroke. Patients receiving unnecessary treatment are in danger of intracranial and other types of bleeding.”
Catheter ablation was successful in 74% of patients, meaning that they had no atrial arrhythmias between three and 12 months after the procedure. Atrial arrhythmias in the first three months were classified as early recurrences and not considered as failure. Some 45% of patients who had a successful procedure were still on antiarrhythmic drugs at 12 months.
Regarding monitoring after the procedure, 83% of patients had at least one cardiology evaluation and 86% had at least one electrocardiogram (ECG). However, just 60% of patients had the recommended serial ECGs and multiday ECG recordings to check for recurrent AF.
“Catheter ablation is not open heart surgery but it is still an invasive procedure that has risks,” said Dr Arbelo. “It is disappointing that 40% of patients are not being comprehensively monitored afterwards.”
Complication rates were 8% in-hospital and 11% during the one-year follow up. “Patients and referring doctors should be aware that complications can occur,” said Dr Arbelo. “Catheter ablation should be done in centres and by electrophysiologists with sufficient experience to minimise the risk.”
References and notes1Arbelo E, et al. Contemporary management of patients undergoing atrial fibrillation ablation: in-hospital and 1-year follow-up findings from the ESC-EHRA atrial fibrillation ablation long-term registry. European Heart Journal. 2017. doi: 10.1093/eurheartj/ehw564 https://doi.org/10.1093/eurheartj/ehw56422016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. European Heart Journal. 2016;37:2893–2962. doi: 10.1093/eurheartj/ehw2103Kirchhof P, et al. Management of atrial fibrillation in seven European countries after the publication of the 2010 ESC Guidelines on atrial fibrillation: primary results of the PREvention oF thromboemolic events--European Registry in Atrial Fibrillation (PREFER in AF). Europace. 2014;16(1):6–14. doi: 10.1093/europace/eut263. Epub 2013 Oct 1.4Lip GY, et al. A prospective survey in European Society of Cardiology member countries of atrial fibrillation management: baseline results of EURObservational Research Programme Atrial Fibrillation (EORP-AF) Pilot General Registry. Europace. 2014;16(3):308–319. doi: 10.1093/europace/eut373. Epub 2013 Dec 17.5Lip GY, et al. Prognosis and treatment of atrial fibrillation patients by European cardiologists: one year follow-up of the EURObservational Research Programme-Atrial Fibrillation General Registry Pilot Phase (EORP-AF Pilot registry). Eur Heart J. 2014;35(47):3365–3376. doi: 10.1093/eurheartj/ehu374. Epub 2014 Aug 31.
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SOURCES OF FUNDING: See the paper for funding sources.
DISCLOSURES: See the paper for disclosures of all authors.
About the European Society of Cardiology
The ESC brings together health care professionals from more than 120 countries, working to advance cardiovascular medicine and help people to live longer, healthier lives.
About the European Heart Rhythm Association
The European Heart Rhythm Association (EHRA) is a registered branch of the European Society of Cardiology (ESC). Its aim is to improve the quality of life of the European population by reducing the impact of cardiac arrhythmias and reducing sudden cardiac death. EHRA promotes science and education in the field of cardiac arrhythmias with a special focus on atrial fibrillation (AF). Besides patient engagement programmes, EHRA organises scientific and educational events for physicians and allied professionals. In cooperation with other associations and societies EHRA promotes the quality of care for patients with AF with the publication of international consensus documents.
About the EURObservational Research Programme
The EURObservational Research Programme (EORP) is the large ESC registry programme. EORP aims at providing a better understanding of medical practice in Europe through the collection of observational data and at evaluating the implementation of ESC guidelines.
About The European Heart Journal
The European Heart Journal is the flagship journal of the European Society of Cardiology. It is published on behalf of the ESC by Oxford Journals, a division of Oxford University Press.
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