Heart rhythm · 2026
Safety and effectiveness of zero-fluoroscopy atrial fibrillation ablation in community hospitals vs tertiary centers.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Navarrete Antonio J, Lambert Nate, Fisch Mark, Hajj Makram, Rios-Meza Hugo, Colter Shannon, Bharath Raju, Whipp Aaron, Iqtidar Faroq, Phookan Sujoy, Mitilesh Das, Miller John
Аннотация
BACKGROUND: Catheter ablation of atrial fibrillation (AF) is primarily performed at tertiary hospitals (THs). The safety and effectiveness of AF ablation at community hospitals (CHs) remains unclear.
OBJECTIVE: This study aimed to assess the long-term efficacy and safety of paroxysmal AF (PAF) ablation at CHs.
METHODS: We retrospectively analyzed patients evaluated at 2 CHs who underwent zero-fluoroscopy (ZF) pulmonary vein isolation at a TH (2015-2017) with those ablated at CHs (2017-2021) after implementation of a local ablation program. Patients were followed up for 24 months (m) with event monitors and self-wearable cardiac monitoring devices. Propensity score matching (PSM) yielded 2 matched cohorts of 290 patients (mean age 66 ± 5 years; 70% male; CHA2DS2-VASc score 1 ± 2; ejection fraction 55%).
RESULTS: No intraprocedural complications or transfers occurred. CH patients had lower AF recurrence at 12 and 18 m (17% vs 29%, P = .010; 23% vs 42%, P = .05), shorter diagnosis-to-ablation time (DAB) (6.1 ± 1.2 m vs 12.4 ± 2.5 m, P = .01), and higher same-day discharge rates (93% vs 70%, P = .010). AF recurrence was similar at 24 m (20%), but repeat ablation was higher in TH patients (27% vs 7%, P = .01). Longer DAB predicted AF recurrence at 18 m (hazard ratio [HR], 2.63; 95% confidence interval [CI], 1.65-4.21), with greater risk for DAB = 6-9 m (HR, 3.13; 95% CI, 2.136-3.13) and DAB >9 m (HR, 3.7; 95% CI, 2.30-3.75) compared with <3 m.
CONCLUSION: Ablation of PAF at CHs with ZF is safe with a shorter DAB and decrease AF recurrences when compared with TH.
OBJECTIVE: This study aimed to assess the long-term efficacy and safety of paroxysmal AF (PAF) ablation at CHs.
METHODS: We retrospectively analyzed patients evaluated at 2 CHs who underwent zero-fluoroscopy (ZF) pulmonary vein isolation at a TH (2015-2017) with those ablated at CHs (2017-2021) after implementation of a local ablation program. Patients were followed up for 24 months (m) with event monitors and self-wearable cardiac monitoring devices. Propensity score matching (PSM) yielded 2 matched cohorts of 290 patients (mean age 66 ± 5 years; 70% male; CHA2DS2-VASc score 1 ± 2; ejection fraction 55%).
RESULTS: No intraprocedural complications or transfers occurred. CH patients had lower AF recurrence at 12 and 18 m (17% vs 29%, P = .010; 23% vs 42%, P = .05), shorter diagnosis-to-ablation time (DAB) (6.1 ± 1.2 m vs 12.4 ± 2.5 m, P = .01), and higher same-day discharge rates (93% vs 70%, P = .010). AF recurrence was similar at 24 m (20%), but repeat ablation was higher in TH patients (27% vs 7%, P = .01). Longer DAB predicted AF recurrence at 18 m (hazard ratio [HR], 2.63; 95% confidence interval [CI], 1.65-4.21), with greater risk for DAB = 6-9 m (HR, 3.13; 95% CI, 2.136-3.13) and DAB >9 m (HR, 3.7; 95% CI, 2.30-3.75) compared with <3 m.
CONCLUSION: Ablation of PAF at CHs with ZF is safe with a shorter DAB and decrease AF recurrences when compared with TH.