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Current Status of Catheter Ablation for Atrial Fibrillation in Japan
Takuto Arita1, Shinya Suzuki1, Katsuhiko Nagai2
1Department of Cardiovascular Medicine, The Cardiovascular Institute.
Insights
Real-world data shows nearly a quarter of atrial fibrillation (AF) patients need repeat catheter ablation. Longer time since AF diagnosis is linked to repeat procedures, while medication discontinuation varies post-ablation.
Area of Science:
- Cardiology
- Medical Informatics
- Health Services Research
Background:
- Catheter ablation is a common treatment for atrial fibrillation (AF).
- Limited real-world data exists on the long-term outcomes of AF patients post-ablation.
- Existing data often comes from registries or specialized centers.
Purpose of the Study:
- To analyze the real-world clinical course of Japanese AF patients after initial catheter ablation.
- To identify factors associated with repeat ablation procedures.
- To examine medication discontinuation rates (oral anticoagulants and antiarrhythmic drugs) post-ablation.
Main Methods:
- Utilized a Japanese health insurance claims database.
- Included 1777 patients who underwent initial AF catheter ablation before June 2016.
- Followed patients for 3 years to track repeat ablations and medication use.
Main Results:
- 22.3% of patients underwent at least one repeat ablation; 4.2% had two or more.
- Longer duration since AF diagnosis was associated with increased likelihood of repeat ablation.
- Discontinuation rates for oral anticoagulants and antiarrhythmic drugs were significant within the first year.
Conclusions:
- This study provides crucial real-world insights into the outcomes of AF catheter ablation in Japan.
- Identifying predictors for repeat procedures and medication management is essential for optimizing patient care.
- Further research can refine treatment strategies based on these real-world findings.
Abstract:
Catheter ablation for atrial fibrillation (AF) has been an established and frequently utilized approach in a variety of clinical settings. Nevertheless, real-world data about the clinical course of AF patients after initial catheter ablation remain limited, and these are mainly derived from particular registries or selected high-volume centers.In this study, we used health check-ups and insurance claims database from a Japanese insurance organization. The study population was comprised of 1777 patients who underwent catheter ablation for AF before June 2016. During the 3-year follow-up period, 396 (22.3%) patients underwent at least one repeated AF ablation, while 74 (4.2%) underwent two or more repeated ablations. In multivariate Cox regression analysis, longer time after AF diagnosis (7-11 months and ≥12 months versus 1-6 months) (HR, 1.05; 95% CI, 1.01-1.08 and HR, 1.04; 95% CI 1.02-1.07) was independently associated with repeated ablation. The discontinuation rates of OACs and AADs after the first ablation were 26.7% and 63.0% at 3 months and 75.2% and 89.1% at 1 year after the initial ablation, respectively. The former was independently associated with shorter time after AF diagnosis and lower diastolic blood pressure, whereas the latter was independently associated with older age, smaller CHADS2 score, and shorter time after AF diagnosis.We presented real-world data regarding the clinical course of young Japanese AF patients after initial catheter ablation based on a claims database in Japan.
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