European survey on efficacy and safety of duty-cycled radiofrequency ablation for atrial fibrillation

Duty-cycled radiofrequency ablation (RFA) has been used for atrial fibrillation (AF) for around 5 years, but large-scale data are scarce. The purpose of this survey was to report the outcome of the technique. A survey was conducted among 20 centres from seven European countries including 2748 patients (2128 with paroxysmal and 620 with persistent AF). In paroxysmal AF an overall success rate of 82 [median 80, interquartile range (IQR) 7490], a first procedure success rate of 72 [median 74 (IQR 5983)], and a success of antiarrhythmic medication of 59 [median 60 (IQR 3972)] was reported. In persistent AF, success rates were significantly lower with 70 [median 74 (IQR 6092)]; P 0.05) as well as the first procedure success rate of 58 [median 55 (IQR 4781)]; P 0.001). The overall success rate was similar among higher and lower volume centres and were not dependent on the duration of experience with duty-cycled RFA (r 0.08, P 0.72). Complications were observed in 108 (3.9) patients, including 31 (1.1) with symptomatic transient ischaemic attack or stroke, which had the same incidence in paroxysmal and persistent AF (1.1 vs. 1.1) and was unrelated to the case load (r 0.24, P 0.15), bridging anticoagulation to low molecular heparin, routine administration of heparin over the long sheath, whether a transoesophageal echocardiogram was performed in every patient or not and average procedure times. Duty-cycled RFA has a self-reported success and complication rate similar to conventional RFA. After technical modifications a prospective registry with controlled data monitoring should be conducted to assess outcome.