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Aims: Pulmonary vein isolation (PVI), the standard for atrial fibrillation (AF) ablation, is most commonly applied with radiofrequency (RF) energy, although cryoballoon technology (CRYO) has gained widespread use. The aim was to compare the second-generation cryoballoon and the irrigated RF energy regarding outcomes and safety., Methods and Results: Of 4657 patients undergoing their first AF ablation, 982 with CRYO and 3675 with RF energy were included from the Swedish catheter ablation registry and the Atrial Fibrillation Ablation Long-Term registry of the European Heart Rhythm Association of the European Society of Cardiology. The primary endpoint was repeat AF ablation. The major secondary endpoints included procedural duration, tachyarrhythmia recurrence, and complication rate. The re-ablation rate after 12 months was significantly lower in the CRYO vs. the RF group, 7.8% vs. 11%, P = 0.005, while freedom from arrhythmia recurrence (30 s duration) did not differ between the groups, 70.2 % vs. 68.2%, P = 0.44. The result was not influenced by AF type and lesion sets applied. In the Cox regression analysis, paroxysmal AF had significantly lower risk for re-ablation with CRYO, hazard ratio 0.56 (P = 0.041). Procedural duration was significantly shorter with CRYO than RF, (mean ± SD) 133.6 ± 45.2 min vs. 174.6 ± 58.2 min, P < 0.001. Complication rates were similar; 53/982 (5.4%) vs. 191/3675 (5.2%), CRYO vs. RF, P = 0.806., Conclusion: The lower re-ablation rates and shorter procedure times observed with the cryoballoon as compared to RF ablation may have important clinical implications when choosing AF ablation technique despite recognized limitations with registries., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2018. For permissions, please email: journals.permissions@oup.com.)

Importance: Quality of life is not a standard primary outcome in ablation trials, even though symptoms drive the indication., Objective: To assess quality of life with catheter ablation vs antiarrhythmic medication at 12 months in patients with atrial fibrillation., Design, Setting, and Participants: Randomized clinical trial at 4 university hospitals in Sweden and 1 in Finland of 155 patients aged 30-70 years with more than 6 months of atrial fibrillation and treatment failure with 1 antiarrhythmic drug or β-blocker, with 4-year follow-up. Study dates were July 2008-September 2017. Major exclusions were ejection fraction <35%, left atrial diameter >60 mm, ventricular pacing dependency, and previous ablation., Interventions: Pulmonary vein isolation ablation (n = 79) or previously untested antiarrhythmic drugs (n = 76)., Main Outcomes and Measures: Primary outcome was the General Health subscale score (Medical Outcomes Study 36-Item Short-Form Health Survey) at baseline and 12 months, assessed unblinded (range, 0 [worst] to 100 [best]). There were 26 secondary outcomes, including atrial fibrillation burden (% of time) from baseline to 12 months, measured by implantable cardiac monitors. The first 3 months were excluded from rhythm analysis., Results: Among 155 randomized patients (mean age, 56.1 years; 22.6% women), 97% completed the trial. Of 79 patients randomized to receive ablation, 75 underwent ablation, including 2 who crossed over to medication and 14 who underwent repeated ablation procedures. Of 76 patients randomized to receive antiarrhythmic medication, 74 received it, including 8 who crossed over to ablation and 43 for whom the first drug used failed. General Health score increased from 61.8 to 73.9 points in the ablation group vs 62.7 to 65.4 points in the medication group (between-group difference, 8.9 points; 95% CI, 3.1-14.7; P = .003). Of 26 secondary end points, 5 were analyzed; 2 were null and 2 were statistically significant, including decrease in atrial fibrillation burden (from 24.9% to 5.5% in the ablation group vs 23.3% to 11.5% in the medication group; difference -6.8% [95% CI, -12.9% to -0.7%]; P = .03). Of the Health Survey subscales, 5 of 7 improved significantly. Most common adverse events were urosepsis (5.1%) in the ablation group and atrial tachycardia (3.9%) in the medication group., Conclusions and Relevance: Among patients with symptomatic atrial fibrillation despite use of antiarrhythmic medication, the improvement in quality of life at 12 months was greater for those treated with catheter ablation compared with antiarrhythmic medication. Although the study was limited by absence of blinding, catheter ablation may offer an advantage for quality of life., Trial Registration: clinicaltrialsregister.eu Identifier: 2008-001384-11.

Aims: Catheter ablation is considered the treatment of choice for many tachyarrhythmias, but convincing 'real-world' data on efficacy and safety are lacking. Using Swedish national registry data, the ablation spectrum, procedural characteristics, as well as ablation efficacy and reported adverse events are reported., Methods and Results: Consecutive patients (≥18 years of age) undergoing catheter ablation in Sweden between 01 January 2006 and 31 December 2015 were included in the study. Follow-up (repeat ablation and vital status) was collected through 31 December 2016. A total of 26 642 patients (57 ± 15 years, 62% men), undergoing a total of 34 428 ablation procedures were included in the study. In total, 4034 accessory pathway/Wolff-Parkinson-White syndrome (12%), 7358 AV-nodal re-entrant tachycardia (21%), 1813 atrial tachycardia (5.2%), 5481 typical atrial flutter (16%), 11 916 atrial fibrillation (AF, 35%), 2415 AV-nodal (7.0%), 581 premature ventricular contraction (PVC, 1.7%), and 964 ventricular tachycardia (VT) ablations (2.8%) were performed. Median follow-up time was 4.7 years (interquartile range 2.7-7.0). The spectrum of treated arrhythmias changed over time, with a gradual increase in AF, VT, and PVC ablation (P < 0.001). Decreasing procedural times and utilization of fluoroscopy with time, were seen for all arrhythmia types. The rates of repeat ablation differed between ablation types, with the highest repeat ablation seen in AF (41% within 3 years). The rate of reported adverse events was low (n = 595, 1.7%). Death in the immediate period following ablation was rare (n = 116, 0.34%)., Conclusion: Catheter ablations have shifted towards more complex procedures over the past decade. Fluoroscopy time has markedly decreased and the efficacy of catheter ablation seems to improve for AF., (© The Author(s) 2018. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Introduction: Left atrial catheter ablation is useful as symptomatic treatment in selected patients with atrial fibrillation (AF). Evaluation requires measurement of arrhythmia-related symptoms. Many of the published protocols have drawbacks and have been used in AF only, with no possible comparison to other ablations that compete for the same resources. U22 is a published protocol that quantifies paroxysmal tachycardia symptoms through scales with 11 answer alternatives, translated into discrete numerical scales 0-10. It has been shown to reflect the clinical improvement after ablation of supraventricular tachycardia. Here we report the use of U22 in measuring improvement after catheter ablation for AF., Material and Methods: A total of 105 patients underwent first-time ablation for AF and answered U22 and SF-36 forms at baseline and follow-up 304 (SD 121) days after ablation. Independently, the patients underwent a clinical follow-up. All decisions regarding medication and reablation were taken without knowledge of the symptom scores. Results. The U22 scores for well-being, arrhythmia as cause for impaired well-being, derived time-aspect score for arrhythmia, and discomfort during attack detected relevant improvements of symptoms after the ablation. U22 showed larger improvement in patients undergoing only one procedure than in patients who later underwent repeated interventions, thus reflecting the independent clinical decision for reablation., Conclusion: U22 quantifies the symptomatic improvement after AF ablation with adequate internal consistency and construct validity. U22 mirrors aspects of the arrhythmia symptomatology other than SF-36.

Introduction: The main indication for ablation of supraventricular tachycardia is symptomatic relief. Generic measures of quality of life are not suitable for direct evaluation of arrhythmia-related symptoms, and a specific tool is needed. The questionnaire U22 quantifies symptoms associated with arrhythmic events. It uses discrete 0-10 scales for quantification of influence of arrhythmia on well-being, intensity of discomfort, type of dominant symptom, and a time aspect that summarizes duration and frequency of spells. We evaluated U22 in a well defined group of patients with paroxysmal supraventricular tachycardia, undergoing an intervention with a distinct end-point and a high success rate., Methods: Symptoms in patients with accessory pathway and atrioventricular nodal re-entrant tachycardia scheduled for ablation were measured with U22 and SF-36 on admission. The evaluation was repeated after 6 months., Results: Altogether 58 patients successfully ablated in 2006-2008 completed the four forms (U22 and SF-36 at base-line and follow-up, 210 ± 35 days after ablation). The score for well-being (0-10; 10 being best) increased from 5.9 ± 2.6 to 7.9 ± 1.9 (P < 0.0005). The score for arrhythmia as cause for impairment in well-being (0-10; 10 being highest) decreased from 7.5 ± 2.8 to 2.0 ± 3.1 (P < 0.0005). The time aspect score (0-10) decreased from 4.7 ± 1.5 to 1.4 ± 1.8 (P < 0.0005). The two SF-36 summary measures PCS and MCS increased from 46.9 ± 9.4 to 48.4 ± 10.7 and from 44.9 ± 12.5 to 49.1 ± 9.9 (P = 0.04 and 0.002)., Conclusion: After successful ablation of accessory pathway and atrioventricular nodal re-entrant tachycardia, the U22 protocol detected a relevant increase in arrhythmia-related well-being. Modest improvement in general well-being was detected by the SF-36 protocol.

Aims: Radiofrequency (RF) ablation requires placement of several catheters at critical positions. The catheters are positioned with fluoroscopy, resulting in a significant radiation exposure. We have investigated to what degree an intracardiac navigation system reduces the fluoroscopy duration in different groups of routine RF ablations., Methods and Results: The fluoroscopy time was evaluated in 365 consecutive routine RF ablations, performed between 2002 and 2005. An intracardiac navigation system (LocaLisa, Medtronic) was used from 2003. The data were prospectively entered into a database and subsequently retrieved, and the procedures classified as being performed with fluoroscopy only or with the aid of the LocaLisa system. After introduction of the LocaLisa system, the median fluoroscopy time decreased from 24 to 10 min in the 141 atrioventricular nodal re-entry tachycardia (AVNRT) ablations and from 43 to 28 min in the 71 atrial flutter (AFl) ablations (P<0.005 for both). In the 145 Wolff-Parkinson-White (WPW) ablations, a decrease from 27 to 23 min was observed (P=0.03). The decrease in AVNRT and AFl, but not in WPW was associated with the introduction of the LocaLisa system., Conclusion: The use of the LocaLisa system during RF ablations significantly reduced the fluoroscopy time in AVNRT and AFl ablations, by a median of 58% and 46%, respectively.