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Real-world outcomes, complications, and cost of catheter-based ablation for atrial fibrillation: an update

Ha, Andrew C.T.; Wijeysundera, Harindra C.; Birnie, David H.; Verma, Atul

Current Opinion in Cardiology: January 2017 - Volume 32 - Issue 1 - p 47–52
doi: 10.1097/HCO.0000000000000348
ARRHYTHMIAS: Edited by David H. Birnie

Purpose of review Catheter-based ablation for atrial fibrillation is a useful and effective form of rhythm-control therapy for symptomatic patients. This article reviews the ‘real-world’ experience on the outcomes, complications, and costs of atrial fibrillation ablation.

Recent findings Currently, real-world outcomes of atrial fibrillation ablation are derived from retrospective analysis of administrative databases or prospective registries from selected centers and patients. The rate of atrial fibrillation recurrence was reported to be as high as 60% and the rate of repeat ablation ranged from ≈10 to 18% within 1 year after ablation. All-cause hospitalizations after atrial fibrillation ablation were frequent, at up to ≈30% within 1 year and with up to half of them related to atrial fibrillation recurrence or repeat procedures. Rates of periprocedural complications were relatively low (≈3%). Female sex was associated with higher risk of complications such as bleeding, vascular injury, and tamponade. Markov models examining the cost-effectiveness of ablation yielded favorable results when success rates of more than 70% were assumed with long time horizons (>5 years).

Summary The real-world outcomes of atrial fibrillation ablation are sobering. Confirmation of these findings with prospective, population-based, minimally biased studies is needed. There is a critical need to delineate the downstream economic impact of atrial fibrillation ablation on society to justify its continued delivery and growth.

aDepartment of Medicine, University of Toronto

bPeter Munk Cardiac Centre, University Health Network

cSunnybrook Health Sciences Centre, Toronto

dUniversity of Ottawa Heart Institute, Ottawa

eSouthlake Regional Health Centre, Newmarket, Ontario, Canada

Correspondence to Andrew C.T. Ha, MD, Division of Cardiology, Toronto General Hospital, 200 Elizabeth Street 3GW-558A, Toronto, ON, Canada. Tel: +416 340 5206; fax: +416 340 3340; e-mail: andrew.ha@uhn.ca

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