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Updated Worldwide Survey on the Methods, Efficacy, and Safety of Catheter Ablation for Human Atrial Fibrillation
Abstract
BACKGROUND: The purpose of this study was to provide an updated worldwide report on the methods, efficacy, and safety of catheter ablation of atrial fibrillation (AF). METHODS AND RESULTS: A questionnaire with 46 questions was sent to 521 centers from 24 countries in 4 continents. Complete interviews were collected from 182 centers, of which 85 reported to have performed 20,825 catheter ablation procedures on 16,309 patients with AF between 2003 and 2006. The median number of procedures per center was 245 (range, 2 to 2715). All centers included paroxysmal AF, 85.9% also included persistent and 47.1% also included long-lasting AF. Carto-guided left atrial circumferential ablation (48.2% of patients) and Lasso-guided ostial electric disconnection (27.4%) were the most commonly used techniques. Efficacy data were analyzed with centers representing the unit of analysis. Of 16,309 patients with full disclosure of outcome data, 10 488 (median, 70.0%; interquartile range, 57.7% to 75.4%) became asymptomatic without antiarrhythmic drugs and another 2047 (10.0%; 0.5% to 17.1%) became asymptomatic in the presence of previously ineffective antiarrhythmic drugs over 18 (range, 3 to 24) months of follow-up. Success rates free of antiarrhythmic drugs and overall success rates were significantly larger in 9590 patients with paroxysmal AF (74.9% and 83.2%) than in 2800 patients with persistent AF (64.8% and 75.0%) and 1108 patients with long-lasting AF (63.1% and 72.3%) (P<0.0001). Major complications were reported in 741 patients (4.5%). CONCLUSIONS: When analyzed in a large number of electrophysiology laboratories worldwide, catheter ablation of AF shows to be effective in approximately 80% of patients after 1.3 procedures per patient, with approximately 70% of them not requiring further antiarrhythmic drugs during intermediate follow-up.
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“In patients who experience symptomatic recurrences of AF despite antiarrhythmic drug therapy, all RCTs showed better sinus rhythm maintenance with catheter ablation than on antiarrhythmic drugs.586,713,727,728”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [727]
In the citing paper
“Five to seven per cent of patients will suffer severe complications after catheter ablation of AF, and 2-3% will experience life-threatening but usually manageable complications.727,[748][749][750]”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [727]
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“– 726,1039 In patients who experience symptomatic recurrences of AF despite antiarrhythmic drug therapy, all RCTs showed better sinus rhythm maintenance with catheter ablation than on antiarrhythmic drugs.(586,713,727,728) There is no current indication for catheter ablation to prevent cardiovascular outcomes (or desi…”
Guidelines for the management of atrial fibrillation
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“It is difficult to directly compare adverse events from AF ablation to those from AADs.”
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“... 51.111.1 Episodes per month, median (IQR), n 13.5 (4.0–30.0) 12.0 (3.0–30.0) 12.0 (4.0–30.0) Duration of episodes, median (IQR), h 4.0 (1.0–12.0) 6.0 (2.0–15.0) 5.5 (1.0–12.0) Patients with 1 DC shock, n (%) 9 (17.0) 12 (20.3) 21 (18.8) Embolic events, n (%) 1 (1.9) 7 (11.9) 8 (7.1) Diabetes mellitus, n (%) 1 (1.9…”
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Self-citationACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: full text
Fuster, V., Rydén, L., Cannom, D. S., Crijns, H. J. G. M., Curtis, A. B., Ellenbogen, K. A., Halperin, J. L., Heuzey, J. L., Kay, G. N., Lowe, J. E., et al. (2006) · EP Europace · doi:10.1093/europace/eul097 · Cited by 670
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“Amiodarone use during blanking period without previous use 0 (0) 4 (3)”
BackgroundMethodInfluentialPrevalence and Causes of Fatal Outcome in Catheter Ablation of Atrial Fibrillation
Cappato, R., Calkins, H. G., Chen, S., Davies, W. D., Iesaka, Y., Kalman, J. M., Kim, Y.-H., Klein, G. J., Natale, A., Packer, D. L., et al. (2009) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2009.02.022 · Cited by 583
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“2104 The past decade has seen catheter ablation of atrial fibril-lation (AF) transition from a new unproven procedure to a commonly performed procedure in most major medical centers throughout the world.1 Catheter ablation of AF has also evolved into a mainstay of therapy for patients with drugrefractory symptomatic A…”
BackgroundResultInfluentialPulsed Field Ablation of Paroxysmal Atrial Fibrillation
Reddy, V. Y., Dukkipati, S. R., Neužil, P., Anić, A., Petrů, J., Funasako, M., Cochet, H., Minami, K., Brešković, T., Sikiric, I., et al. (2021) · JACC. Clinical electrophysiology · doi:10.1016/j.jacep.2021.02.014 · Cited by 569
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Paroxysmal AF Catheter Ablation With a Contact Force Sensing Catheter
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“48%) fell within the typical range published in the literature (1,17,18).”
BackgroundGuidelines for Pharmacotherapy of Atrial Fibrillation (JCS 2013)
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Venice Chart International Consensus Document on Atrial Fibrillation Ablation
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“Furthermore, CA had an acceptable safety profile according to the latest international registries.(17)”
MethodResultWann, L. S., Curtis, A. B., Ellenbogen, K. A., Estes, N. A. M., Ezekowitz, M. D., Jackman, W. M., January, C. T., Lowe, J. E., Page, R. L., Slotwiner, D. J., et al. (2011) · Heart Rhythm · doi:10.1016/j.hrthm.2011.01.032 · Cited by 394
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“3%.(3,19,20) The recently published SMART-AF trial with another CF-sensing ablation catheter reported a higher cardiac tamponade rate of 2.”
Radiofrequency Catheter Ablation of Atrial Fibrillation: A Cause of Silent Thromboembolism?
Gaïta, F., Caponi, D., Pianelli, M., Scaglione, M., Toso, E., Cesarani, F., Boffano, C., Gandini, G., Valentini, M. C., Ponti, R. D., et al. (2010) · Circulation · doi:10.1161/circulationaha.110.937953 · Cited by 363
Andrade, J. G., Khairy, P., Guerra, P. G., Deyell, M. W., Rivard, L., Macle, L., Thibault, B., Talajic, M. R., Roy, D., & Dubuc, M. (2011) · Heart Rhythm · doi:10.1016/j.hrthm.2011.03.050 · Cited by 360
Incidence of Asymptomatic Intracranial Embolic Events After Pulmonary Vein Isolation
Herrera‐Siklody, C., Deneke, T., Hocini, M., Lehrmann, H., Shin, D., Miyazaki, S., Henschke, S., Flügel, P.-C., SCHIEBELING‐RÖMER, J., Bansmann, P. M., et al. (2011) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2011.04.010 · Cited by 357
“conventional RF ablation (5), recent evidence suggests a higher rate of subclinical cerebral emboli detected by imaging (6).”
BackgroundLakkireddy, D., Reddy, Y. M., Biase, L. D., Vanga, S. R., Santangeli, P., Swarup, V., Pimentel, R., MANSOUR, M. C., d’Ávila, A., Sánchez, J., et al. (2012) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2011.12.014 · Cited by 356
Chun, K. R. J., Schmidt, B., Metzner, A., Tilz, R. R., Zerm, T., Köster, I., Fürnkranz, A., Koektuerk, B., Konstantinidou, M., Antz, M., et al. (2008) · European Heart Journal · doi:10.1093/eurheartj/ehn570 · Cited by 350
“... RIPV: hockey stick 18 28 2 2 1 1 100 19 28 4 1 9 100 LCPV: crosstalk; RIPV: pull-down; LIPV: pull-down 20 28 4 1 5 100 LCPV: crosstalk; RIPV: pull-down; LIPV: pull-down 21 28 2 3 1 8 100 RIPV: pull-down 22 28 2 2 3 3 100 RIPV: pull-down 23 28 3 2 1 3 100 RIPV: pull-down 24 28 2 2 1 3 100 RIPV: pull-down 25 28 2 3…”
Phrenic Nerve Injury After Atrial Fibrillation Catheter Ablation
Sacher, F., Monahan, K. H., Thomas, S. P., Davidson, N. C., Adragão, P., Sanders, P., Hocini, M., Takahashi, Y., Rotter, M., Rostock, T., et al. (2006) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2006.02.050 · Cited by 345
Fuster, V., Rydén, L., Cannom, D. S., Crijns, H. J. G. M., Curtis, A. B., Ellenbogen, K. A., Halperin, J. L., Heuzey, J. L., Kay, G. N., Lowe, J. E., et al. (2006) · Circulation · doi:10.1161/circulationaha.106.177031 · Cited by 345
Sandau, K. E., Funk, M., Auerbach, A. D., Barsness, G. W., Blum, K., Cvach, M. M., Lampert, R., May, J. L., McDaniel, G. M., Perez, M. V., et al. (2017) · Circulation · doi:10.1161/cir.0000000000000527 · Cited by 370
Peters, D. C., Wylie, J. V., Hauser, T. H., Kissinger, K. V., Botnar, R. M., Essebag, V., Josephson, M. E., & Manning, W. J. (2007) · Radiology · doi:10.1148/radiol.2433060417 · Cited by 336
Valsartan for Prevention of Recurrent Atrial Fibrillation
Modena, M. G. (2009) · New England Journal of Medicine · doi:10.1056/nejmx090019 · Cited by 328
Brieger, D. B., Amerena, J. V., Attia, J., Bajorek, B. V., Chan, K. H., Connell, C., Freedman, B., Ferguson, C., Hall, T. L., Haqqani, H. M., et al. (2018) · Heart Lung and Circulation · doi:10.1016/j.hlc.2018.06.1043 · Cited by 335
“3% internationally, although they are thought to be lower in Australian practice [344].”
Sánchez‐Quintana, D., Cabrera, J. Á., Climent, V. E., Farré, J., de Mendonça, M. C., & Ho, S. Y. (2005) · Circulation · doi:10.1161/circulationaha.105.551291 · Cited by 320
Complications of Catheter Ablation of Atrial Fibrillation
Gupta, A., Perera, T., Ganesan, A. N., Sullivan, T., Lau, D. H., Roberts‐Thomson, K. C., Brooks, A. G., & Sanders, P. (2013) · Circulation Arrhythmia and Electrophysiology · doi:10.1161/circep.113.000768 · Cited by 318
“9%).(6,13) There was also a lower pooled incidence of procedure-related deaths (0.”
BackgroundInfluentialClinical Outcomes of Catheter Substrate Ablation for High-Risk Patients With Atrial Fibrillation
Nademanee, K., Schwab, M., Kosar, E. M., Karwecki, M., Moran, M. D., Visessook, N., Michael, A. D., & Ngarmukos, T. (2008) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2007.10.044 · Cited by 318
A novel radiofrequency ablation catheter using contact force sensing: Toccata study
Kück, K., Reddy, V. Y., Schmidt, B., Natale, A., Neužil, P., Saoudi, N. C., Kautzner, J., Herrera‐Siklody, C., Hindricks, G., Jaı̈s, P., et al. (2011) · Heart Rhythm · doi:10.1016/j.hrthm.2011.08.021 · Cited by 311
“8 Range 21–77 42–73 Sex, n (%) Male 29 (67) 23 (68) Cardiovascular history, n (%) Cardiac disorders 14 (33) 8 (24) Secondary arrhythmia 6 (14) 4 (12) Coronary artery disease 4 (9) 1 (3) Heart failure 1 (2) 2 (6) Valvular disease 2 (5) 1 (3) Other cardiac disorder 2 (5) 3 (9) Vascular disorders 22 (51) 20 (59) Hyperten…”
Conen, D., Tedrow, U. B., Koplan, B. A., Glynn, R. J., Buring, J. E., & Albert, C. M. (2009) · Circulation · doi:10.1161/circulationaha.108.830042 · Cited by 312
Scherr, D., Khairy, P., Miyazaki, S., Aurillac-Lavignolle, V., Pascale, P., Wilton, S. B., Ramoul, K., Komatsu, Y., Roten, L., Jadidi, A., et al. (2015) · Circulation Arrhythmia and Electrophysiology · doi:10.1161/circep.114.001943 · Cited by 303
“sistent with the current worldwide experience with this procedure.(1,22)”
BackgroundBelle, Y. V., Janse, P., Rivero‐Ayerza, M., Thornton, A. S., Jessurun, E., Theuns, D., & Jordaens, L. J. L. M. (2007) · European Heart Journal · doi:10.1093/eurheartj/ehm227 · Cited by 299
Biase, L. D., Burkhardt, J. D., Mohanty, P. K., Sánchez, J., Horton, R., Gallinghouse, G. J., Lakkireddy, D., Verma, A., Khaykin, Y., Hongo, R. H., et al. (2010) · Circulation · doi:10.1161/circulationaha.109.921320 · Cited by 293
Kistler, P. M., Ho, S. Y., Rajappan, K., MORPER, M., Harris, S. J., Abrams, D. J., Sporton, S. C., & SCHILLING, R. J. (2007) · Journal of Cardiovascular Electrophysiology · doi:10.1111/j.1540-8167.2007.00981.x · Cited by 290
Pulmonary Vein Isolation for the Maintenance of Sinus Rhythm in Patients With Atrial Fibrillation
Piccini, J. P., Lópes, R. D., Kong, M. H., Hasselblad, V., JACKSON, K. P., & Al‐Khatib, S. M. (2009) · Circulation Arrhythmia and Electrophysiology · doi:10.1161/circep.109.856633 · Cited by 289
Gaïta, F., Leclercq, J. F., Schumacher, B., Scaglione, M., Toso, E., Halimi, F., Schade, A., Froehner, S., Ziegler, V., Sergi, D., et al. (2011) · Journal of Cardiovascular Electrophysiology · doi:10.1111/j.1540-8167.2011.02050.x · Cited by 290
Complications of Catheter Ablation for Atrial Fibrillation: Incidence and Predictors
SPRAGG, D. D., Dalal, D., Cheema, A., SCHERR, D., Chilukuri, K., Cheng, A., Henrikson, C. A., Marine, J. E., Berger, R. D., Dong, J., et al. (2008) · Journal of Cardiovascular Electrophysiology · doi:10.1111/j.1540-8167.2008.01181.x · Cited by 286
Shah, R. U., Freeman, J. V., Shilane, D. A., Wang, P. J., Go, A. S., & Hlatky, M. A. (2012) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2011.08.068 · Cited by 281
Randomized Ablation Strategies for the Treatment of Persistent Atrial Fibrillation
Dixit, S., Marchlinski, F. E., Lin, D., Callans, D. J., Bala, R., Riley, M. P., Garcia, F. C., Hutchinson, M. D., Ratcliffe, S. J., Cooper, J. M., et al. (2011) · Circulation Arrhythmia and Electrophysiology · doi:10.1161/circep.111.966226 · Cited by 281
“The following settings were used to identify CFE: (1) for NavX, 5-second segments were acquired with a refractory period of 50 milliseconds (width, 10; sensitivity, 0.5–1.0 mV); (2) for CARTO, 2.5-second segments were acquired with a threshold of 0.05 to 0.5 mV. CFEs were considered present when the mean fractionation…”
MethodInfluentialBleeding risk assessment and management in atrial fibrillation patients
Fauchier, L., Hylek, E. M., Knight, E., Lane, D. A., Levi, M. M., Marín, F. R., Palareti, G., Jp, C., Rubboli, A., Poli, D., et al. (2011) · Thrombosis and Haemostasis · doi:10.1160/th11-10-0690 · Cited by 283
DAGRES, N., HINDRICKS, G., KOTTKAMP, H., SOMMER, P., GASPAR, T., BODE, K., ARYA, A., HUSSER, D., RALLIDIS, L. S., KREMASTINOS, D. T., et al. (2009) · Journal of Cardiovascular Electrophysiology · doi:10.1111/j.1540-8167.2009.01493.x · Cited by 279
Luik, A., Radzewitz, A., Kieser, M., Walter, M., Bramlage, P., Hörmann, P., Schmidt, K., Horn, N., Brinkmeier-Theofanopoulou, M., Kunzmann, K., et al. (2015) · Circulation · doi:10.1161/circulationaha.115.016871 · Cited by 275
Bohnen, M., Stevenson, W. G., Tedrow, U. B., Michaud, G. F., John, R. M., Epstein, L. M., Albert, C. M., & Koplan, B. A. (2011) · Heart Rhythm · doi:10.1016/j.hrthm.2011.05.017 · Cited by 275
Outcomes and complications of catheter ablation for atrial fibrillation in females
Patel, D., Mohanty, P. K., Biase, L. D., Sánchez, J., Shaheen, M. H., Burkhardt, J. D., Bassouni, M., Cummings, J. E., Wang, Y., Lewis, W. R., et al. (2009) · Heart Rhythm · doi:10.1016/j.hrthm.2009.10.025 · Cited by 272
Kistler, P. M., Rajappan, K., JAHNGIR, M., Earley, M. J., Harris, S. J., Abrams, D. J., Gupta, D., Liew, R., Ellis, S. M., Sporton, S. C., et al. (2006) · Journal of Cardiovascular Electrophysiology · doi:10.1111/j.1540-8167.2006.00594.x · Cited by 272
Gammie, J. S., Haddad, M., Milford-Beland, S., Welke, K. F., Ferguson, T. B., O’Brien, S. M., Griffith, B. P., & Peterson, E. D. (2008) · The Annals of Thoracic Surgery · doi:10.1016/j.athoracsur.2007.10.097 · Cited by 264
Kuck, K.-H., Hoffmann, B. A., Ernst, S., Wegscheider, K., Treszl, A., Metzner, A., Eckardt, L., Lewalter, T., Breithardt, G., & Willems, S. (2016) · Circulation Arrhythmia and Electrophysiology · doi:10.1161/circep.115.003337 · Cited by 261
“The Gap-AF–AFNET 1 trial was a prospective, multicenter, 2-arm randomized, adaptive trial to investigate the significance of complete linear PVI on the outcome of patients with drug-refractory paroxysmal AF.”
ResultInfluentialGuidelines for Pharmacotherapy of Atrial Fibrillation (JCS 2013):– Digest Version –
JCSJointWorkingGroup (2014) · Circulation · Cited by 261
Post-cardiac injury syndromes. An emerging cause of pericardial diseases
Imazio, M., & Hoit, B. D. (2012) · International Journal of Cardiology · doi:10.1016/j.ijcard.2012.09.052 · Cited by 260
Reddy, V. Y., Gibson, D. N., Kar, S., O’Neill, W. W., Doshi, S. K., Horton, R., Buchbinder, M., Gordon, N. T., & Holmes, D. R. (2016) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2016.10.010 · Cited by 258
“31% in a worldwide survey of 20,835 procedures (18) and 1.”
BackgroundGlobal Burden of Atrial Fibrillation in Developed and Developing Nations
Chugh, S. S., Roth, G. A., Gillum, R. F., & Mensah, G. A. (2014) · Global Heart · doi:10.1016/j.gheart.2014.01.004 · Cited by 257
“Almost 2 decades ago, therapeutic catheter-based radiofrequency ablation was introduced into the AF treatment armamentarium and is currently finding increasing use but is restricted largely to high-income countries [40].”
BackgroundLong-Term Quality of Life After Ablation of Atrial Fibrillation
Wokhlu, A., Monahan, K. H., Hodge, D. O., Asirvatham, S. J., Friedman, P. A., Munger, T. M., Bradley, D. J., Bluhm, C. M., Haroldson, J. M., & Packer, D. L. (2010) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2010.01.040 · Cited by 242
Postoperative Arrhythmias after Cardiac Surgery: Incidence, Risk Factors, and Therapeutic Management
Peretto, G., Durante, A., Limite, L. R., & Cianflone, D. (2014) · Cardiology Research and Practice · doi:10.1155/2014/615987 · Cited by 243
“However, inconsistent data about results of LA ablation following POAF have been published so far [95].”
BackgroundLip, G. Y. H., Fauchier, L., Freedman, S. B., Gelder, I. C. V., Natale, A., Gianni, C., Nattel, S., Potpara, T., Rienstra, M., Tse, H., et al. (2016) · Nature Reviews Disease Primers · doi:10.1038/nrdp.2016.16 · Cited by 248
Kück, K., Lebedev, D. S., Mikhaylov, E. N., Romanov, A. B., Gellér, L., Kalējs, O., Neumann, T., Davtyan, K. V., On, Y. K., Popov, S. V., et al. (2020) · EP Europace · doi:10.1093/europace/euaa298 · Cited by 236
Wann, L. S., Curtis, A. B., January, C. T., Ellenbogen, K. A., Lowe, J. E., Estes, N. A. M., Page, R. L., Ezekowitz, M. D., Slotwiner, D. J., Jackman, W. M., et al. (2010) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2010.10.001 · Cited by 229
Management of atrial fibrillation
Lip, G. Y., & Tse, H.-F. (2007) · The Lancet · doi:10.1016/s0140-6736(07)61300-2 · Cited by 229
Pulmonary Vein Stenosis Complicating Ablation for Atrial Fibrillation
Holmes, D. R., Monahan, K. H., & Packer, D. L. (2009) · JACC: Cardiovascular Interventions · doi:10.1016/j.jcin.2008.12.014 · Cited by 226
Metadata
- Authors
- Cappato, R., Calkins, H., Chen, S.-A., Davies, W., Iesaka, Y., Kalman, J., Kim, Y.-H., Klein, G., Natale, A., Packer, D., Skanes, A., Ambrogi, F., & Biganzoli, E.
- Affiliations
- The Royal Melbourne Hospital (AU)
- ORCID
- Venue
- Circulation Arrhythmia and Electrophysiology
- Published
- 2010-02
- Volume
- 3
- Issue
- 1
- Pages
- 32-38
- ISSN
- 1941-3084 (ISSN-L)
- 1941-3149
- OpenAlex
- W2146673314
- Cited by
- 2,852
- References
- 34
- Citations by year
- 2026: 26 · 2025: 42 · 2024: 51 · 2023: 68 · 2022: 81 · 2021: 110 · 2020: 126 · 2019: 125 · 2018: 141 · 2017: 177 · 2016: 199 · 2015: 184 · 2014: 220 · 2013: 246 · 2012: 218
- FWCI
- 156.54
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation Arrhythmia and Electrophysiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Keywords
- catheter ablation, atrial fibrillation, paroxysmal atrial fibrillation, persistent atrial fibrillation, ablation efficacy, ablation safety, procedural complications, CARTO system
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Anticoagulants, Atrial Fibrillation, Data Collection, Female, Humans, Male, Middle Aged, Surveys and Questionnaires, Treatment Outcome, Catheter Ablation, Young Adult
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