Clin Res Cardiol (2023). https://doi.org/10.1007/s00392-023-02180-w
Outcomes of patients undergoing ablation for atrial fibrillation or flutter – insights from the German Ablation Quality Registry
J. Hartmann1, M. A. Gunawardene1, M. Hochadel2, J. Senges3, J. Brachmann4, T. Deneke5, F. Straube6, D. Thomas7, H. Ince8, L. Eckardt9, S. Willems1
1Kardiologie, Asklepios Klinik St. Georg, Hamburg; 2Statistik, IHF GmbH, Ludwigshafen am Rhein; 3Stiftung Institut für Herzinfarktforschung, Ludwigshafen am Rhein; 4Medical School / Regiomed GmbH, Coburg; 5Klinik für Kardiologie II / Interventionelle Elektrophysiologie, RHÖN-KLINIKUM AG Campus Bad Neustadt, Bad Neustadt a. d. Saale; 6Klinik für Kardiologie und Internistische Intensivmedizin, München Klinik Bogenhausen, München; 7Klinik für Innere Med. III, Kardiologie, Angiologie u. Pneumologie, Universitätsklinikum Heidelberg, Heidelberg; 8Klinik für Innere Medizin, Kardiologie und konservative Intensivmedizin, Vivantes Klinikum Am Urban, Berlin; 9Klinik für Kardiologie II - Rhythmologie, Universitätsklinikum Münster, Münster;

Aims: To analyze outcomes of patients undergoing catheter ablation for either atrial fibrillation (AF) or common type atrial flutter (AFL) within a prospective German Ablation Quality Registry.

Methods and results: Data from 8418 patients who underwent catheter ablation for chronic (persistent to permanent) AF (n=1826, 21.7%), paroxysmal AF (n=2840, 33.7%) and AFL (n=3752, 44,6%) between January 2007 and January 2010 were prospectively collected. Patients were followed for at least 1 year. Compared to the AF ablation groups, patients undergoing ablation for AFL were older (AFL 65.9 ± 11.1 vs. chronic AF 62.7 ± 10.3 vs. paroxysmal AF 60.1 ± 10.6 years, p < 0.001) and had a higher prevalence of co-morbidities, especially coronary heart disease (AFL 31.6% vs. chronic AF 22.3% vs. paroxysmal AF 16.9%, p < 0.001), chronic kidney disease (AFL 8.1% vs. chronic AF 6.6% vs. paroxysmal AF 2.4%, p < 0.001) and diabetes (AFL 16.2% vs. chronic AF 9.3% vs. paroxysmal AF 7.7%, p < 0.001). Ablation procedures for AFL were significantly shorter (Median: AFL 70 vs. chronic AF 178 vs. paroxysmal AF 165 minutes, p < 0.001) and associated with fewer arrhythmia recurrence during short and long-time follow-up. Furthermore, there were fewer repeat ablation procedures required and less frequently antiarrhythmic drug therapy used than in the AF ablation groups. Despite this success in antiarrhythmic management, one year mortality (AFL 2.8% vs. chronic AF 2.1% vs. paroxysmal AF 0.9%, p < 0.001) and the combined endpoint of mortality, stroke, myocardial infarction and major bleeding events were significantly higher in patients in the AFL ablation group (AFL 4.2% vs. chronic AF 3.7% vs. paroxysmal AF 1.4%, p < 0.001).

Conclusion: Patients undergoing ablation for AFL had a significantly increased risk of mortality at one year follow up compared to patients undergoing ablation for chronic or paroxysmal AF despite higher long-term success rates of AFL ablation procedures. Advanced age and a high prevalence of cardiovascular co-morbidities in the AFL ablation group constitute a remarkable difference in patient characteristics that may explain the poorer outcome despite superior success of the antiarrhythmic therapy.

 

 

AFL

Chronic AF

Paroxysmal AF

P-Value

Patients

3752 (44,6%)

1828 (21,7%)

2840 (33,7%)

 

Age (years)

65.9 ± 11.1

62.7 ± 10.3

AF 60.1 ± 10.6

P < 0.001

Cardiomyopathy

7.1% (265/3752)

8.7% (159/1826)

3.0% (86/2840)

P < 0.001

Coronary artery disease

31.6% (1185/3752)

22.3% (407/1826)

16.9% (481/2840)

P < 0.001

Chronic kidney disease

8.1% (44/543)

6.6% (19/289)

2.4% (12/494)

P < 0.001

Diabetes mellitus

16.2% (606/3752)

9.3% (169/1826)

7.7% (220/2840)

P < 0.001

Ablation procedure duration (Median, minutes)

70 (50, 110)

178 (126, 220)

165 (12, 210)

P < 0.001

Recurrence during follow-up

30.0 % (1030/3436)

47.1% (807/1713)

44.6% (1217/2728)

P < 0.001

Mortality (Kaplan Meier)

2.6%

1.9%

0.3%

P < 0.001

Death, Myocardial infarction, Stroke, Major Bleeding (Kaplan Meier)

4.2%

3.7%

1.4%

P < 0.001


https://dgk.org/kongress_programme/jt2023/aP473.html