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(Circulation. 2005;111:1100-1105.)
© 2005 American Heart Association, Inc.

Arrhythmia/Electrophysiology

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; 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.

Correspondence to Riccardo Cappato, MD, Arrhythmia and Electrophysiology Center, Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Milan, Italy. E-mail rcappato{at}libero.it

Received March 10, 2004; revision received December 13, 2004; accepted December 21, 2004.

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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Circulation 2005 111: 1093. [Extract] [Full Text]