An analysis of clinical data by researchers at Brigham and Women’s Hospital has found that radiofrequency (RF)-based ablation has a success rate of 85.7% treating atrial fibrillation (AF) one year after the procedure. Of those patients who responded, nearly 90% were able to cease taking antiarrhythmic drugs, according to the research published Saturday in the journal Heart Rhythm.
“When we incorporate what we think are the best strategies for radiofrequency-based ablation, we can further improve the long-term patient outcomes,” said Paul Zei, MD, PhD, an electrophysiologist and physician-researcher at Brigham and Women’s Hospital and the study’s corresponding author. “With high-volume experienced operators using these best practices, we are reporting excellent short and long-term clinical outcomes, with more than 80% long-term success and very low complication rates.”
RF-based ablation works by using radiofrequency energy to inactivate the heart tissue that is causing the irregular electric signals that cause heart arrhythmia. Previous randomized, controlled clinical trials have shown the procedure to be beneficial, but with the technique continuing to evolve, the Brigham and Women’s team wanted to demonstrate how effective it is in the real-world clinical setting.
For this study, the team used data from the REAL-AF registry which was created by Zei in 2019 to gather data from multiple sites for the evaluation of long-term clinical outcomes and management of AF patients. The registry has more than 50 centers that perform a high volume of RF-based ablation contributing data. These centers use best-practice techniques such as focusing on the pulmonary vein, reducing or eliminating the use of fluoroscopy during the procedure, and using shorter, but higher blasts of radiofrequency to reduce the time needed for the procedure.
In total, the investigators analyzed data from 2,470 patients in the REAL-AF registry who had undergone RF-based ablation for paroxysmal AF, a form of the disease characterized by short bursts of AF followed by normal heart rhythm for extended periods. For this group the researchers evaluated the RF-based ablation time and technique and gathered patient outcomes data from directly after the procedure and again 12 months later.
Data showed the procedure in the REAL-AF registry were safer, more effective, and more efficient compared with data from previous randomized clinical trials. At the one-year follow up date, 81.6% of patients were from all-atrial arrhythmia, while 85.7% of patients were AF-free. In addition, 93.2% of patients reported no arrhythmia symptoms over the follow up period.
The team also noted that the procedures themselves were completed faster, which improves the safety by requiring patients to spend less time under anesthesia.
Zei noted the research into RF-based ablation is ongoing, while highlighting the role of the REAL-AF registry. “An important next step will be to apply similar strategies to try to understand how this procedure can be improved for patients with the persistent type of AF, which is more difficult to treat than paroxysmal AF,” he said.
“As well as being a study, the registry is a learning health network. We’re not only evaluating the best approach for RF-based ablation; we’re also learning from each other. The goal is to disseminate best practices across every operator and center.”
