Atrial fibrillation (AF) is the most common cardiac sustained heart rhythm disorder
encountered in clinical practice, with current estimates suggesting it affects up
to 3% of the general population.
1
In addition to reductions in quality of life, AF is responsible for the majority
of arrhythmia-related healthcare utilization (emergency room visits and hospital admissions),
and is associated with a significant risk of stroke/systemic thromboembolism, cognitive
dysfunction, and premature mortality.
1
,2
Over the past 25 years, percutaneous catheter ablation, which is centered on electrical
isolation of triggering foci within the pulmonary veins, has moved from an investigational
therapy to the standard of care for sinus rhythm maintenance as both an initial (“first-line”)
and “second-line” therapy (i.e., when antiarrhythmic drugs have been ineffective,
are contraindicated, or produce intolerable adverse effects).
1
,3
,
4
,
5
In addition to reducing arrhythmia recurrence, catheter ablation provides clinically
meaningful benefits on patient-reported outcomes, clinically important improvements
in quality of life and exercise performance, significantly reduces healthcare resource
utilization, and does not increase the risk of adverse events compared with pharmacotherapy.
3
,4
As a result, catheter ablation of AF has become the most commonly performed ablation
procedure in most electrophysiology centers worldwide, with an annual population-adjusted
growth rate that exceeds all other cardiovascular procedures.
6
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References
- The 2020 Canadian Cardiovascular Society/Canadian Heart Rhythm Society Comprehensive Guidelines for the Management of Atrial Fibrillation.Can J Cardiol. 2020; 36: 1847-1948
- The clinical profile and pathophysiology of atrial fibrillation: relationships among clinical features, epidemiology, and mechanisms.Circ Res. 2014; 114: 1453-1468
- Catheter Ablation Versus Medical Therapy for Atrial Fibrillation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.Circ Arrhythm Electrophysiol. 2019; 12e007414
- Cryoballoon Ablation as Initial Treatment for Atrial Fibrillation: JACC State-of-the-Art Review.J Am Coll Cardiol. 2021; 78: 914-930
- Management of Atrial Fibrillation in 2021: An Updated Comparison of the Current CCS/CHRS, ESC, and AHA/ACC/HRS Guidelines.Can J Cardiol. 2021; 37: 1607-1618
- Ten-year trends in the use of catheter ablation for treatment of atrial fibrillation vs. the use of coronary intervention for the treatment of ischaemic heart disease in Australia.Europace. 2013; 15: 1702-1709
- Cryoballoon or Radiofrequency Ablation for Atrial Fibrillation Assessed by Continuous Monitoring: A Randomized Clinical Trial.Circulation. 2019; 140: 1779-1788
- Catheter Ablation for Persistent Atrial Fibrillation.N Engl J Med. 2015; 373: 878-879
- Adenosine-guided pulmonary vein isolation for the treatment of paroxysmal atrial fibrillation: an international, multicentre, randomised superiority trial.Lancet. 2015; 386: 672-679
- Cryoablation or Drug Therapy for Initial Treatment of Atrial Fibrillation.N Engl J Med. 2021; 384: 305-315
- Risk of Mortality Following Catheter Ablation of Atrial Fibrillation.J Am Coll Cardiol. 2019; 74: 2254-2264
- Efficacy and Safety of Same-Day Discharge for Atrial Fibrillation Ablation.JACC Clin Electrophysiol. 2020; 6: 609-619
- Utilisation and safety of catheter ablation of atrial fibrillation in public and private sector hospitals.BMC Health Serv Res. 2021; 21: 883
Article Info
Publication History
Accepted:
June 23,
2022
Received in revised form:
June 21,
2022
Received:
June 13,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Journal Subject Codes:
[5] Arrhythmias, clinical electrophysiology, drugs
[22] Ablation/ICD/surgery
[106] Electrophysiology
Conflicts of Interest Disclosures
Dr. JG Andrade reports grants and personal fees from Medtronic, grants from Baylis, personal fees from Biosense-Webster. Dr L Macle reports grants and personal fees from Biosense-Webster, personal fees from Abbott and Medtronic.
Funding sources: None
Identification
Copyright
© 2022 Published by Elsevier Inc. on behalf of the Canadian Cardiovascular Society.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Low 30-day Mortality after Atrial Fibrillation Ablation; Results from the Netherlands Heart Registration: NHR-AF Mortality StudyCanadian Journal of Cardiology
- PreviewThis study presents the 30-day mortality of patients who underwent atrial fibrillation (AF) ablation between 2013 – 2020 and were registered in the Netherlands Heart Registration. In total, 30,197/30,238 (99.9%) patients were analyzed. Fifteen (0.05%) died within 30 days. Nine deaths were considered procedurally related, four were considered non-procedural related, and in two patients the cause of death was unknown.
- Full-Text
- Preview
