Author + information
- George Leefa,b,
- Andrew Cluckeya,b,
- Fahd Yunusa,b,
- Mariam Askaria,b,
- Ewoud Schuita,b,
- Paul Heidenreicha,b,
- Mintu Turakhiaa,b and
- Alexander Perinoa,b
Background: We sought to characterize trends over time of success rates of studies evaluating non-paroxysmal atrial fibrillation (NPAF) ablation.
Methods: We performed a systematic review and meta-analysis of NPAF ablation from 1/1/1990 to 8/1/2016 searching PubMed, Scopus, and Cochrane databases. Major exclusion criteria were insufficient outcome reporting and ablation strategies that were not prespecified and uniform. We included treatment arms with ≥ 40% NPAF patients from single procedure studies only. Multivariate meta-regressions controlled for age, sex, NPAF percentage, study design, follow-up duration, rhythm monitoring intensity, antiarrhythmic use, NPAF recurrence definition, and ablation energy type, equipment, and lesions set.
Results: A total of 119 treatment arms from 83 studies (12,712 patients) met inclusion. Unadjusted success rates ranged from 84.9% in 2003 to 66.4% in 2016, decreasing 1.2% per year (p 0.001) (Figure). After controlling for all covariates, success rates decreased non-significantly (-1.0% per year, p 0.09). Studies prior to 2009 had shorter durations of follow-up, less intense rhythm monitoring, and were less likely to be randomized. In a contemporary sub-cohort (2009 – 2016), success rates were stable in both univariate and multivariate analyses.
Conclusions: Among published studies over the past 13 years, success rates for NPAF ablation have not meaningfully improved over time despite substantial developments in ablation approaches and technology.
Poster Hall, Hall C
Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Atrial Fibrillation and VT: Specific Situations and Newer Outcome Measures
Abstract Category: 8. Arrhythmias and Clinical EP: Supraventricular/Ventricular Arrhythmias
Presentation Number: 1190-099
- 2017 American College of Cardiology Foundation