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Circulation. 2005
Published online before print February 21, 2005, doi: 10.1161/01.CIR.0000157153.30978.67
A more recent version of this article appeared on March 8, 2005
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Submitted on March 10, 2004
Revised on December 13, 2004
Accepted on December 21, 2004

Worldwide Survey on the Methods, Efficacy, and Safety of Catheter Ablation for Human Atrial Fibrillation

Riccardo Cappato MD*, Hugh Calkins MD, Shih-Ann Chen MD, Wyn Davies MD, Yoshito Iesaka MD, Jonathan Kalman MD, You-Ho Kim MD, George Klein MD, Douglas Packer MD, and Allan Skanes MD

From the Arrhythmias and Electrophysiology Center (R.C.), Policlinico San Donato, Milan, Italy; Johns Hopkins University School of Medicine (H.C.), Baltimore, Md; Veterans General Hospital (S.-A.C.), Taipei, Taiwan; St. Mary’s Hospital (W.D.), London, UK; Cardiovascular Center (Y.I.), Tsuchiura Kyodo Hospital, Tsuchiura Ibaraki, Japan; Royal Melbourne Hospital (J.K.), Parkville, VIC, Australia; Cardiology Department (Y.-H.K.), Asan Medical Center, Seoul, South Korea; Department of Cardiology (G.K., A.S.), University Hospital, London ON, Canada; and Division of Cardiology (D.P.), Mayo Foundation--St. Mary Hospital, Rochester, Minn.

* To whom correspondence should be addressed. E-mail: rcappato{at}libero.it.

Background--The purpose of this study was to conduct a worldwide survey investigating the methods, efficacy, and safety of catheter ablation (CA) of atrial fibrillation (AF).

Methods and Results--A detailed questionnaire was sent to 777 centers worldwide. Data relevant to the study purpose were collected from 181 centers, of which 100 had ongoing programs on CA of AF between 1995 and 2002. The number of patients undergoing this procedure increased from 18 in 1995 to 5050 in 2002. The median number of procedures per center was 37.5 (range, 1 to 600). Paroxysmal AF, persistent AF, and permanent AF were the indicated arrhythmias in 100.0%, 53.0%, and 20.0% of responding centers, respectively. The most commonly used techniques were right atrial compartmentalization between 1995 and 1997, ablation of the triggering focus in 1998 and 1999, and electrical disconnection of multiple pulmonary veins between 2000 and 2002. Of 8745 patients completing the CA protocol in 90 centers, of whom 2389 (27.3%) required >1 procedure, 4550 (52.0%; range among centers, 14.5% to 76.5%) became asymptomatic without drugs and another 2094 (23.9%; range among centers, 8.8% to 50.3%) became asymptomatic in the presence of formerly ineffective antiarrhythmic drugs over an 11.6±7.7-month follow-up period. At least 1 major complication was reported in 524 patients (6.0%).

Conclusions--The findings of this survey provide a picture of the variable and evolving methods, efficacy, and safety of CA for AF as practiced in a large number of centers worldwide and may serve as a guide to clinicians considering therapeutic options in patients suffering from this arrhythmia.


Key words: fibrillation • catheter ablation • antiarrhythmia agents • follow-up studies


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EuropaceHome page
M. E.W. Hemels, J. H. Ruiter, G. P. Molhoek, N. J.G.M. Veeger, A. C.P. Wiesfeld, A. V. Ranchor, M. van Trigt, A. Pilmeyer, I. C. Van Gelder, and for The Features in AT500TM study; Chances for pat
Right atrial preventive and antitachycardia pacing for prevention of paroxysmal atrial fibrillation in patients without bradycardia: a randomized study
Europace, March 1, 2008; 10(3): 306 - 313.
[Abstract] [Full Text] [PDF]


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EuropaceHome page
Y.-F. Hu, C.-T. Tai, Y.-J. Lin, S.-L. Chang, L.-W. Lo, W. Wongcharoen, A. R. Udyavar, T.-C. Tuan, and S.-A. Chen
The change in the fluoroscopy-guided transseptal puncture site and difficult punctures in catheter ablation of recurrent atrial fibrillation
Europace, March 1, 2008; 10(3): 276 - 279.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
K. Nademanee, M. C. Schwab, E. M. Kosar, M. Karwecki, M. D. Moran, N. Visessook, A. D. Michael, and T. Ngarmukos
Clinical Outcomes of Catheter Substrate Ablation for High-Risk Patients With Atrial Fibrillation
J. Am. Coll. Cardiol., February 26, 2008; 51(8): 843 - 849.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
W. Moreira, R. Manusama, C. Timmermans, B. Ghaye, S. Philippens, H. J.J. Wellens, and L.-M. Rodriguez
Long-Term Follow-Up After Cryothermic Ostial Pulmonary Vein Isolation in Paroxysmal Atrial Fibrillation
J. Am. Coll. Cardiol., February 26, 2008; 51(8): 850 - 855.
[Abstract] [Full Text] [PDF]


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EuropaceHome page
M. Schmidt, G. Nolker, H. Marschang, K.-J. Gutleben, V. Schibgilla, H. Rittger, A.-M. Sinha, G. Ritscher, D. Mayer, J. Brachmann, et al.
Incidence of oesophageal wall injury post-pulmonary vein antrum isolation for treatment of patients with atrial fibrillation
Europace, February 1, 2008; 10(2): 205 - 209.
[Abstract] [Full Text] [PDF]


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CirculationHome page
C. Pratola, E. Baldo, P. Notarstefano, T. Toselli, and R. Ferrari
Radiofrequency Ablation of Atrial Fibrillation: Is the Persistence of All Intraprocedural Targets Necessary for Long-Term Maintenance of Sinus Rhythm?
Circulation, January 15, 2008; 117(2): 136 - 143.
[Abstract] [Full Text] [PDF]


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Ann. Thorac. Surg.Home page
J. H. Wudel, P. Chaudhuri, and J. J. Hiller
Video-Assisted Epicardial Ablation and Left Atrial Appendage Exclusion for Atrial Fibrillation: Extended Follow-Up
Ann. Thorac. Surg., January 1, 2008; 85(1): 34 - 38.
[Abstract] [Full Text] [PDF]


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J Am Coll Cardiol ImgHome page
L. F. Tops, S. C. Krishnan, J. D. Schuijf, M. J. Schalij, and J. J. Bax
Noncoronary applications of cardiac multidetector row computed tomography.
J. Am. Coll. Cardiol. Img., January 1, 2008; 1(1): 94 - 106.
[Abstract] [Full Text] [PDF]


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Card Surg AdultHome page
R. E. Eckart and L. M. Epstein
Interventional Therapy for Atrial and Ventricular Arrhythmias
Card. Surg. Adult, January 1, 2008; 3(2008): 1357 - 1374.
[Full Text]


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RadiologyHome page
T. D. Bahnson
Clinician's Commentary on Saremi et al
Radiology, January 1, 2008; 246(1): 108 - 109.
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JAMAHome page
J. E. Marine
Catheter Ablation Therapy for Supraventricular Arrhythmias
JAMA, December 19, 2007; 298(23): 2768 - 2778.
[Abstract] [Full Text] [PDF]


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CirculationHome page
S. J. Asirvatham
Ablation for Atrial Fibrillation: Can We Decrease Thromboembolism Without Increasing the Risk for Bleeding?
Circulation, November 27, 2007; 116(22): 2517 - 2519.
[Full Text] [PDF]


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Ann. Thorac. Surg.Home page
A. M. Gillinov
Choice of Surgical Lesion Set: Answers From the Data
Ann. Thorac. Surg., November 1, 2007; 84(5): 1786 - 1792.
[Abstract] [Full Text] [PDF]


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EuropaceHome page
D. G. Katritsis and A. J. Camm
Catheter ablation of atrial fibrillation: do we know what we are doing?
Europace, November 1, 2007; 9(11): 1002 - 1005.
[Full Text] [PDF]