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Updated: May 3, 2026
Robotic Ablation of Atrial Fibrillation
Published on: May 29, 2015
Score associated with the outcome after multiple ablation procedures in patients with atrial fibrillation
Maciej Wójcik1, Alexander Berkowitsch, Sergey Zaltsberg
1Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany; Department of Cardiology, Medical University of Lublin, Lublin, Poland.
Insights
Multiple catheter ablation procedures improve atrial fibrillation outcomes, especially in patients with higher ALARMEC scores. Antiarrhythmic drugs further enhance success rates in these complex cases.
Area of Science:
- Cardiology
- Electrophysiology
Background:
- Catheter ablation (CA) is a key treatment for atrial fibrillation (AF).
- Achieving satisfactory outcomes often requires multiple procedures (MPs).
- Patient risk stratification is crucial for predicting CA success.
Purpose of the Study:
- To evaluate the effectiveness of multiple catheter ablation procedures (MPs) in treating atrial fibrillation (AF).
- To assess outcomes based on patient risk stratification using the ALARMEC score.
- To determine the impact of antiarrhythmic drugs (AADs) on AF ablation success.
Main Methods:
- A cohort of 911 AF patients undergoing catheter ablation (CAAF) was followed for 60 months.
- The ALARMEC risk score (Atrial fibrillation type, Left Atrium size, Renal insufficiency, MEtabolic syndrome, cardiomyopathy) was calculated for each patient.
- Maintenance of sinus rhythm was the primary endpoint.
Main Results:
- Overall success improved from 56% after the first procedure to 76% with MPs.
- Higher ALARMEC scores correlated with increased need for MPs and decreased success rates.
- Patients on AADs showed varied success rates based on ALARMEC score, while those without AADs generally had better outcomes.
Conclusions:
- Multiple catheter ablation procedures significantly improve AF management outcomes.
- The ALARMEC score effectively stratifies patients, predicting the need for MPs and guiding treatment intensity.
- Adjunctive antiarrhythmic drug therapy can further enhance success rates, particularly in higher-risk individuals.
Background:
Catheter ablation (CA) of atrial fibrillation (AF) is now established therapeutic option. Multiple procedures (MPs) are often needed to achieve the satisfactory outcome. The aim of the study was to assess the outcome after MPs in AF patients categorized to risk-score groups.
Methods:
We followed a cohort of consecutive 911 (69% male; median 59 years) patients with AF (58% paroxysmal) who had CAAF performed. ALARMEC (Atrial fibrillation type, Left Atrium size, Renal insufficiency, MEtabolic syndrome, cardiomyopathy) risk score was calculated for each patient. The end point was maintenance of sinus rhythm at the follow-up of 60 months.
Results:
We performed 1,199 CAAF procedures. One, two, and three procedures were performed in 663 (73%), 208 (23%), and 40 (4%) patients, respectively. Outcome after the first procedure (56%) was improved with MPs (76%). MPs > 2 were performed in 1%, 3%, 5%, 6%, and 10% patients with ALARMEC score of 0, 1, 2, 3, and 4, respectively. MPs were successful in 89%, 86%, 81%, 65%, and 43% of patients with ALARMEC score of 0, 1, 2, 3, and 4, respectively. Outcome in 174 (19%) patients on antiarrhythmic drugs (AADs) was 85%, 68%, 75%, 44%, and 39% in ALARMEC score: 0, 1, 2, 3, and 4, respectively. Outcome in 737 (81%) patients without AAD was 90%, 85%, 80%, 77%, and 69% in ALARMEC score of 0, 1, 2, 3, and 4, respectively.
Conclusion:
The moderate success rate after index procedure of CAAF can be further improved with multiple ones and AAD.
