Abstract 20708: Secular Trends in Reported Success Rates of Catheter Ablation for Paroxysmal Atrial Fibrillation: Findings From the SMASH-AF Meta-Analysis Study Cohort
Introduction: Approaches, tools, and technologies for catheter ablation for paroxysmal atrial fibrillation (PAF) have evolved significantly since its inception. We sought to characterize secular trends in PAF ablation single procedure success rates.
Methods: We performed a systematic review and meta-analysis of ablation strategy heterogeneity in atrial fibrillation (SMASH-AF) from January 1st, 1990 to May 1st, 2016 searching PubMed, Scopus, and Cochrane databases. The full protocol is registered with PROSPERO. We included trials and observational studies reporting AF ablation success rate, safety profile, quality of life outcomes, or cost. Major exclusion criteria were insufficient reporting of outcomes, sample size < 40 patients, and ablation strategies that were not prespecified and uniform. We included treatment arms that were at least two-thirds PAF patients. Single procedure freedom from tachyarrhythmia off antiarrhythmic agents was the primary outcome and other definitions of success were secondary outcomes. Analyses used a random-effects model and multivariate meta-regressions included year of publication, mean age, percent female, mean duration of follow-up, and recurrence screening modality.
Results: A total of 270 treatment arms from 194 studies (29,686 patients) met inclusion. Unadjusted success rates ranged from 70.3% in 2003 to 75.6% in 2016, with a drop in 2007 followed by a rise (Figure). After controlling for covariates, there was a 0.5% increase in success rate per year from 2003-2016 (p 0.05, I2 residual 88.0%) and a 1.3% increase in success rate per year from 2008-2016 (p 0.002, I2 residual 85.5%).
Conclusions: Since 2003, success rates of trials and observational studies of PAF ablation have improved only incrementally. An abrupt drop in 2007 may be related to new guidelines on post-procedure monitoring. With the current trend, meaningfully improvement in success rate is unlikely to occur without major paradigm or technology changes.
Author Disclosures: A.C. Perino: None. G.C. Leef: None. A. Cluckey: None. F.N. Yunus: None. M. Askari: None. P.A. Heidenreich: None. M. Turakhia: Research Grant; Modest; Medtronic, Inc., iRhythm Technologies. Research Grant; Significant; Janssen Pharmaceuticals, Inc. Consultant/Advisory Board; Modest; Medtronic, Inc., Daiichi, Sankyo Pharmaceuticals., St Jude Medical, Precision Health Economics.
- © 2016 by American Heart Association, Inc.