Monday, September 03, 2012


Well radio-frequency ablation is now done at many centers following the French experience. Some of my patients are asking for it. Although single centers like the expert center at Bordeaux do very well, what is the overall picture when one looks across the board, as more an more centers take on the procedure.
We get a glimpse of this, when Dr Elena Arbela of Hospital Clinic Universitari de Barcelona. presented the registry data from the Atrial Fibrillation Ablation Study, at the recently concluded ESC 2012, at Munich. This is a group of about 1,400 patients with atrial fibrillation. About half had HBP and about a third were older than 65yrs. 30% had lone AF, and the majority had paroxysmal AF.

Mortality and complication rates, 1400 patients undergoing AF ablation

Complications/events In-hospital (%) Postdischarge (%)
All complications 7.7 2.6
Major complications 1.7 0.8
Mortality 0.07 0.31
CV mortality 0.07 0.16

The procedure success rate was about 73.7%.  One year after the procedure, 88% were in sinus rhythm, and 30% had readmission for Atrial Fibrillation or other arrhythmia s. After i year, 65% were still on warfarin, for one reason or another. Few of them had 24Hrs Holter monitoring. 32% were still on anti-arrhythmic agents. These data were from 10 European centers who were now doing AF ablation routinely. About 54% were symptom free at 1 year.

I must say that looking at it overall, obviously , the procedure is complex and has a mortality. Should not be taken lightly. The success rate is only 77%, meaning that 23% were not successful. Although 88% were in Sinus rhythm at 1 year, routine 24 hrs ECG ambulatory monitoring were not done. So we can never be sure. Only 54% were symptom free at 1 year.
Baring the side -effects of warfarin, I am sure that I can get  50% of my patients symptom free at 1 year with rate control. Occasionally, I can also get them to sinus rhythm, especially those with paroxysmal AFib, especially when I do not routinely monitor them.

I think there is still away to go, with AFib ablation. We need to achieve something close to 95% success rate and also have them off drugs ( anti-arrhythmics and also anti-coagulants ) at 1 year. I am sure that the "electricians" amongst us ( that is what we call the electro-physiologist ), will get it better in no time.

For the moment, maybe good rate control, and anti-coagulations to prevent stroke, maybe the way to go.

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