Featured Research

from universities, journals, and other organizations

One-quarter of high risk patients denied anticoagulation after AF ablation

Date:
February 18, 2014
Source:
European Society of Cardiology (ESC)
Summary:
Catheter ablation of AF maintained sinus rhythm in 74% of patients overall, a new European study has found, indicating very good long-term results for AF ablation across Europe, with success of the procedure consistent across European regions. Both success and complication rates were not influenced by the number of AF ablations the health centers performed each year, and overall, a consistently high success rate and few complications in medium to high volume centers was found. Inconsistent use of anticoagulants and antiarrhythmic drugs at one year shows that follow-up needs to be improved.

One-quarter of high risk patients do not receive anticoagulants after ablation of atrial fibrillation (AF), according to the latest survey of European practice.

The EORP Atrial Fibrillation Ablation Pilot Study, conducted by the European Heart Rhythm Association (EHRA) of the European Society of Cardiology (ESC), reveals that 65% of patients were taking anticoagulants one year after ablation of AF.1 But up to 25% of patients at high risk of stroke (defined as a CHA2DS2-VASc score >1) were not taking any anticoagulant drug. And around half of patients with a low stroke risk (CHA2DS2-VASc score of 0) were still anticoagulated one year after the procedure.

Study author Professor Josep Brugada, Hospital Clinic, University of Barcelona, said: "Our pilot study was in medium to high volume AF ablation centres and we would expect them to be following anticoagulation protocols. But often the follow-up is performed by a GP or general cardiologist at another centre. Good collaboration between the two centres is absolutely mandatory to ensure that patients received recommended treatments."

This was a prospective, observational registry of consecutive patients undergoing a first AF ablation procedure in 10 European countries. It included 1 410 patients from 72 cardiology centres with medium to high expertise (defined as performing >50 AF ablations per year). The current analysis of one-year follow-up data is published in European Heart Journal.2 It provides a contemporary picture of European AF ablation success and complication rates, and how centres assess success of the procedure.

The study found that catheter ablation of AF maintained sinus rhythm in 74% of patients overall. Success without antiarrhythmic drugs was achieved in 41% of patients. When post-ablation atrial flutter/tachycardia were excluded, complications occurred in 2.5% of patients and fewer than 1% were considered major. While 90% of patients had symptoms before the ablation, 55% had no symptoms afterwards.

Professor Brugada said: "In this survey of medium to high expertise centres the overall success rate of AF catheter ablation is relatively high and the overall complication rate is relatively low. The study protocol did not require discontinuation of antiarrhythmic therapy after the 3-month blanking period although it is considered good practice when there is no arrhythmia recurrence."

He added: "We found that protocols for antiarrhythmic therapy were followed more strictly in Northern Europe. Physicians did not give the medication unless the patient had a documented arrhythmia recurrence. It could be that in Southern Europe there is a tendency to give antiarrhythmic drugs if patients have symptoms, without requiring specific documentation of an arrhythmia."

Arrhythmia recurrences during the 3-month blanking period were the only predictor of failure 12 months after the procedure. Doctor Elena Arbelo, co author, also from the Hospital Clinic of Barcelona, said: "Patients who had an atrial arrhythmia during the first 3 months were more likely to have an arrhythmia after the blanking period. But an arrhythmia during the blanking period should not prompt an early re-ablation because 63% of these patients did not have a later arrhythmia. We should still wait for 3 months to assess the real result of the ablation."

Success of the procedure was consistent across European regions. Both success and complication rates were not influenced by the number of AF ablations the centres performed each year. Professor Brugada said: "These results were not surprising because all centres in the study had medium to high expertise and 50 procedures per year is probably above the cut-off point for quality. We are currently conducting the long term registry which includes all centres and we may find different results in the low volume centres."

The one year follow up was performed in-person for 58% of patients while 42% were followed up by telephone. In-person follow-up was more frequent in Southern and Eastern Europe. Dr Arbelo said: "The high level of telephone contact suggests that 1 centre performed the ablation and another conducted the follow up. It shows how different real life is from clinical studies which require intense follow up monitoring with devices to document arrhythmia recurrences and symptoms."

Professor Brugada concluded: "We found a consistently high success rate and few complications in medium to high volume centres across Europe. But inconsistent use of anticoagulants and antiarrhythmic drugs at one year shows that follow-up needs to be improved. Close cooperation between centres performing ablations and physicians doing the follow-up is essential to ensure that all patients in Europe receive appropriate treatment after the procedure."


Story Source:

The above story is based on materials provided by European Society of Cardiology (ESC). Note: Materials may be edited for content and length.


Journal Reference:

  1. E. Arbelo, J. Brugada, G. Hindricks, A. P. Maggioni, L. Tavazzi, P. Vardas, C. Laroche, F. Anselme, G. Inama, P. Jais, Z. Kalarus, J. Kautzner, T. Lewalter, G. H. Mairesse, J. Perez-Villacastin, S. Riahi, M. Taborsky, G. Theodorakis, S. A. Trines. The Atrial Fibrillation Ablation Pilot Study: an European Survey on Methodology and * Results of Catheter Ablation for Atrial Fibrillation: conducted by the European Heart Rhythm Association. European Heart Journal, 2014; DOI: 10.1093/eurheartj/ehu001

Cite This Page:

European Society of Cardiology (ESC). "One-quarter of high risk patients denied anticoagulation after AF ablation." ScienceDaily. ScienceDaily, 18 February 2014. <www.sciencedaily.com/releases/2014/02/140218100624.htm>.
European Society of Cardiology (ESC). (2014, February 18). One-quarter of high risk patients denied anticoagulation after AF ablation. ScienceDaily. Retrieved September 18, 2014 from www.sciencedaily.com/releases/2014/02/140218100624.htm
European Society of Cardiology (ESC). "One-quarter of high risk patients denied anticoagulation after AF ablation." ScienceDaily. www.sciencedaily.com/releases/2014/02/140218100624.htm (accessed September 18, 2014).

Share This



More Health & Medicine News

Thursday, September 18, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

The Cost of Ebola

The Cost of Ebola

Reuters - Business Video Online (Sep. 18, 2014) As Sierra Leone prepares for a three-day "lockdown" in its latest bid to stem the spread of Ebola, Ciara Lee looks at the financial implications of fighting the largest ever outbreak of the disease. Video provided by Reuters
Powered by NewsLook.com
What HealthKit Bug Means For Your iOS Fitness Apps

What HealthKit Bug Means For Your iOS Fitness Apps

Newsy (Sep. 18, 2014) Apple has delayed the launch of the HealthKit app platform, citing a bug. Video provided by Newsy
Powered by NewsLook.com
Residents Vaccinated as Haiti Fights Cholera Epidemic

Residents Vaccinated as Haiti Fights Cholera Epidemic

AFP (Sep. 18, 2014) Haitians receive the second dose of the vaccine against cholera as part of the UN's vaccination campaign. Duration: 00:34 Video provided by AFP
Powered by NewsLook.com
Raw: Elephant Undergoes Surgery in Tbilisi Zoo

Raw: Elephant Undergoes Surgery in Tbilisi Zoo

AP (Sep. 18, 2014) Grand the elephant has successfully undergone surgery to remove a portion of infected tusk at Tbilisi Zoo in Georgia. British veterinary surgeons used an electric drill to extract the infected piece. (Sept. 18) Video provided by AP
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins