Department of Cardiology, Helios Frankenwaldklinik Kronach, Kronach, Germany.
Department for Cardiovascular Diseases, University Hospital Center Split, Split, Croatia.
Europace. 2023 Feb 16;25(2):676-681. doi: 10.1093/europace/euac194.
Atrial fibrillation (AF) is a major challenge for the healthcare field. Pulmonary vein isolation is the most effective treatment for the maintenance of sinus rhythm. However, clinical endpoints for the procedure vary significantly among studies. There is no consensus on the definition of recurrence and no clear roadmap on how to deal with recurrences after a failed ablation. The purpose of this study was to perform a survey in order to show how clinicians currently approach this knowledge gap. An online survey, supported by the European Heart Rhythm Association (EHRA) Scientific Initiatives Committee, was conducted between 1 April 2022 and 8 May 2022. An anonymous questionnaire was disseminated via social media and EHRA newsletters, for clinicians to complete. This consisted of 18 multiple-choice questions regarding rhythm monitoring, definitions of a successful ablation, clinical practices after a failed AF ablation, and the continuance of anticoagulation. A total of 107 replies were collected across Europe. Most respondents (82%) perform routine monitoring for AF recurrences after ablation, with 51% of them preferring a long-term monitoring strategy. Cost was reported to have an impact on the choice of monitoring strategy. Self-screening was recommended by most (71%) of the respondents. The combination of absence of symptoms and recorded AF was the definition of success for most (83%) of the respondents. Cessation of anticoagulation after ablation was an option mostly for patients with paroxysmal AF and a low CHA2DS2-VASc score. The majority of physicians perform routine monitoring after AF ablation. For most physicians, the combination of the absence of symptoms and electrocardiographic endpoints defines a successful result after AF ablation.
心房颤动 (AF) 是医疗保健领域面临的主要挑战。肺静脉隔离是维持窦性心律最有效的治疗方法。然而，研究中该手术的临床终点差异很大。对于复发的定义没有共识，也没有明确的路线图来处理消融失败后的复发。本研究的目的是进行一项调查，以展示临床医生目前如何处理这一知识差距。一项在线调查得到了欧洲心脏病学会心律协会 (EHRA) 科学倡议委员会的支持，于 2022 年 4 月 1 日至 5 月 8 日进行。通过社交媒体和 EHRA 通讯发布了一份匿名问卷，供临床医生填写。问卷包括 18 个关于节律监测、消融成功的定义、消融失败后的临床实践以及抗凝药物继续使用的多项选择题。共在欧洲收集了 107 份回复。大多数受访者 (82%) 在消融后常规监测 AF 复发，其中 51%的人更喜欢长期监测策略。成本被报告对监测策略的选择有影响。大多数受访者 (71%) 建议进行自我筛查。大多数受访者 (83%) 认为无症状和记录到的 AF 缺失是成功的定义。大多数医生选择在消融后停止抗凝治疗，这主要适用于阵发性 AF 和 CHA2DS2-VASc 评分低的患者。大多数医生在 AF 消融后进行常规监测。对于大多数医生来说，无症状和心电图终点的组合定义了 AF 消融后的成功结果。
