Feature | September 11, 2012

Gold Standard of Success Defined for AF Ablation

Update on consensus statement on management of atrial fibrillation

September 11, 2012 — Since the previous consensus document was published in 2007, catheter and surgical ablation of atrial fibrilliation (AF) have become standard treatments and more randomized trials of ablation versus optimal drug therapy for AF have been conducted. “Significantly more data exist on techniques, success rates and complications of these new interventions, making this a more valid document compared to 2007,” said Professor Karl Heinz Kuck of Germany, president-elect of the European Heart Rhythm Association (EHRA) and co-chair of the task force that developed the latest document.

“Data from randomized trials clearly indicate that catheter ablation is superior to any drug treatment for recurrences of AF and quality of life. But the long term outcome is not as good as we thought in 2007,” added Kuck.

Newly analyzed data on the long-term outcome after successful ablation of long-standing persistent AF shows that just 40 to 50 percent of patients remain free of recurrent AF after five years. The increased volume of data enabled the authors to calculate minimum acceptable success rates for the different types of AF for the first time. Success was defined as freedom from AF, atrial flutter (AFL) and atrial tachycardia (AT) and no antiarrhythmic drug therapy. At 12 months following the ablation procedure, the minimum acceptable success rates are 50 percent for paroxysmal AF, 40 percent for persistent AF and 30 percent for longstanding persistent AF.

Also for the first time, the authors state that the maximum overall complication rate should be in the region of 4.5 percent. “For an invasive procedure, you want to know how successful it is but you also want to know how risky is it,” said Kuck. “In this paper we clearly define the maximum overall complication rate so that patients can see if an institute is performing adequately.”

Standards are clearly set out for the design of clinical trials. The minimum set of data that should be published is outlined, along with the endpoints and definitions that should be used. “This should increase standardization of trials and enable researchers, patients and organizations to compare success and complication rates more easily,” said Kuck.

Another new feature in the 2012 document is a recommendation to perform catheter ablation in patients with paroxysmal AF and no or minimal underlying heart disease as a first-line treatment. Previous recommendations said these patients should first receive an anti-arrhythmic drug and only proceed to catheter ablation if the drug failed.

“This comprehensive state-of-the-art review of the field of catheter and surgical ablation of AF sets out standards for success rates, complication rates and clinical trial design. This will help patients, doctors, researchers and organizations to see which doctors and institutions are up to scratch and where improvements are needed,” concluded Kuck.

“Forty-five experts from around the world representing seven different organizations have come together to develop a consensus for successful catheter and surgical ablation of atrial fibrillation. It is our hope that this guidance will help to ensure that patients seeking treatment will receive high quality care regardless of where they live and also bring us one step closer to ending pain and suffering due to heart rhythm disorders,” said Anne M. Gillis, M.D., FHRS, president of Heart Rhythm Society.

For more information: www.hrsonline.org

Related Content

warfarin, atrial fibrillation, kidney failure, HRS 2016
News | Antiplatelet and Anticoagulation Therapies| May 06, 2016
Atrial fibrillation patients taking warfarin are at higher risk of developing kidney failure if anticoagulation levels...
SCAI 2016, PCI, bleeding risk, bivalirudin, NCDR risk calculator, clinical trial
News | Antiplatelet and Anticoagulation Therapies| May 06, 2016
The largest risk-directed study by a national hospital system demonstrates a 40 percent decline in bleeding events for...
CSI, Cardiovascular Systems Inc, Diamondback 360 Coronary Orbital Atherectomy System, OAS, ORBIT II study, three-year results, SCAI 2016
News | Atherectomy Devices| May 06, 2016
May 6, 2016 — Cardiovascular Systems Inc.
TOBA-BTK study, twelve-month results, SCAI 2016, Tack Endovascular System, critical limb ischemia
News | Peripheral Arterial Disease (PAD)| May 05, 2016
Intact Vascular Inc. announced that positive twelve-month results from its Tack Optimized Balloon Angioplasty – Below-...
Acutus Medical, AcQMap EP Imaging and Mapping System, CE Mark
News | EP Mapping and Imaging Systems| May 04, 2016
Acutus Medical announced CE Mark approval for its AcQMap High Resolution Imaging and Mapping System and AcQMap Catheter...
Biotronik, FDA, MR Conditional CRT devices, Iperia HF-T, defibrillator, ProMRI
Technology | Cardiac Resynchronization Therapy Devices (CRT)| May 03, 2016
Biotronik announced U.S. Food and Drug Administration (FDA) approval of Iperia ProMRI HF-T, a cardiac resynchronization...
radiation dose in the cath lab
News | Radiation Dose Management| May 02, 2016
May 2, 2016 — Starting at the Society for Cardiovascular Angiography and Interventions (SCAI) 2016 annual meeting May
AtriCure, AtriClip PRO2 LAA Exclusion System, left atrial appendage, FDA clearance
Technology | Left Atrial Appendage (LAA) Occluders| April 29, 2016
April 29, 2016 — AtriCure Inc. announced U.S.
microtubules, heartbeat mechanics, Perelman School of Medicine study

Microtubules in a cardiomyocyte at rest (top) and when compressed. Image courtesy of the lab of Ben Prosser, Ph.D., Perelman School of Medicine, University of Pennsylvania

News | EP Lab| April 29, 2016
Using new high-resolution microscopy, researchers have found that molecular struts called microtubules (MT) interact...
Boston Scientific, FDA, ImageReady MR-Conditional Pacing System
Technology | EP Lab| April 28, 2016
Boston Scientific has received U.S. Food and Drug Administration (FDA) approval for a suite of products deemed safe for...
Overlay Init