Catheter ablation for atrial fibrillation: Results from a European survey

Current data are limited regarding how electrophysiologists are integrating emerging technologies and updated atrial fibrillation (AF) guidelines into clinical practice.

This survey aimed to analyze the periprocedural management of patients undergoing AF ablation across Europe.

An online-based questionnaire was conducted between September and November 2024. An additional set of questions was sent to all participants 6 months later.

A total of 203 physicians from 23 European countries participated; 53% had > 10 years of experience as electrophysiologists, 58% worked in university hospitals, and 63% worked in centers performing more than 400 procedures annually. Preprocedural imaging is routinely used by 53%, with computed tomography being the most common modality (47.7%). General anesthesia is used by 42.4%, and 29.6% of physicians do not interrupt anticoagulants before the procedure. In paroxysmal AF ablation, pulmonary vein isolation is the main strategy (93%). Point-by-point radiofrequency (RF) was the predominant energy source (68%), with 65% of physicians performing RF adopting a high-power strategy (> 50 W). For persistent AF ablation, high-density mapping catheters are used by 82.8%, and 66.4% perform additional lesions beyond pulmonary vein isolation, most commonly targeting low-voltage areas and aiming at posterior wall isolation. Between the 2 phases of the survey, half of the physicians switched from RF or cryoballoon to pulsed field ablation. Intermittent use of 24-hour Holter is the primary strategy in 44.3% of cases for monitoring AF recurrence.

This survey highlights some discrepancies between the routine clinical practice of European physicians performing AF ablation and European guidelines, emphasizing the need for better integration of emerging technologies and greater adherence to updated protocols across Europe.