Aims The purpose of this study was to evaluate adherence to national guidelines on the non-pharmacologic (ablative) treatment of atrial fibrillation (AF). Methods and results This prospective, observational, transversal study enrolled 1256 consecutive in- and outpatients referred to 43 cardiology departments between 1 and 31 October 2008 for the management of AF as a primary diagnosis. A rhythmcontrol strategy (cardioversion, antiarrhythmic medication, pace-maker implantation, substrate ablation, alone or in combination) was prescribed in 865 (69%) of the patients and a rate-control strategy [drugs, atrioventricular junction ablation and pace-maker implantation (Ablate and Pace)] in 285 (23%). Specifically, substrate catheter ablation was indicated by the attending cardiologist in 187 (14.9%) patients and Ablate and Pace in 29 (2.3%). According to guideline indications, substrate catheter ablation would have been indicated in 183 (14.6%) patients, but only 105 (57%) of these were correctly identified by the attending cardiologist (K statistics for agreement for indications 0.49). Atrioventricular junction ablation and pace-maker implantation would have been indicated in 108 (8.6%) patients, but only 29 (27%) of these were correctly identified by the attending cardiologist (K statistics for agreement for indications 0.06). Conclusion About a quarter of patients referred to cardiology departments for AF management have potential indications for non-pharmacological treatment according to the guidelines. Substrate catheter ablation was offered by the attending cardiologist in a percentage similar to that expected, but concordance with guideline indications was moderate. Atrioventricular junction ablation and pace-maker implantation was largely underused.

Aims The purpose of this study was to evaluate adherence to national guidelines on the non-pharmacologic (ablative) treatment of atrial fibrillation (AF). Methods and results This prospective, observational, transversal study enrolled 1256 consecutive in-and outpatients referred to 43 cardiology departments between 1 and 31 October 2008 for the management of AF as a primary diagnosis. A rhythm-control strategy (cardioversion, antiarrhythmic medication, pace-maker implantation, substrate ablation, alone or in combination) was prescribed in 865 (69) of the patients and a rate-control strategy [drugs, atrioventricular junction ablation and pace-maker implantation (Ablate and Pace)] in 285 (23). Specifically, substrate catheter ablation was indicated by the attending cardiologist in 187 (14.9) patients and Ablate and Pace in 29 (2.3). According to guideline indications, substrate catheter ablation would have been indicated in 183 (14.6) patients, but only 105 (57) of these were correctly identified by the attending cardiologist (K statistics for agreement for indications 0.49). Atrioventricular junction ablation and pace-maker implantation would have been indicated in 108 (8.6) patients, but only 29 (27) of these were correctly identified by the attending cardiologist (K statistics for agreement for indications 0.06). Conclusion About a quarter of patients referred to cardiology departments for AF management have potential indications for non-pharmacological treatment according to the guidelines. Substrate catheter ablation was offered by the attending cardiologist in a percentage similar to that expected, but concordance with guideline indications was moderate. Atrioventricular junction ablation and pace-maker implantation was largely underused. Published on behalf of the European Society of Cardiology. © The Author 2010.

Adherence to guidelines for atrial fibrillation management of patients referred to cardiology departments: Studio Italiano multicentrico sul Trattamento della Fibrillazione Atriale (SITAF).

DE PONTI, ROBERTO;
2010-01-01

Abstract

Aims The purpose of this study was to evaluate adherence to national guidelines on the non-pharmacologic (ablative) treatment of atrial fibrillation (AF). Methods and results This prospective, observational, transversal study enrolled 1256 consecutive in-and outpatients referred to 43 cardiology departments between 1 and 31 October 2008 for the management of AF as a primary diagnosis. A rhythm-control strategy (cardioversion, antiarrhythmic medication, pace-maker implantation, substrate ablation, alone or in combination) was prescribed in 865 (69) of the patients and a rate-control strategy [drugs, atrioventricular junction ablation and pace-maker implantation (Ablate and Pace)] in 285 (23). Specifically, substrate catheter ablation was indicated by the attending cardiologist in 187 (14.9) patients and Ablate and Pace in 29 (2.3). According to guideline indications, substrate catheter ablation would have been indicated in 183 (14.6) patients, but only 105 (57) of these were correctly identified by the attending cardiologist (K statistics for agreement for indications 0.49). Atrioventricular junction ablation and pace-maker implantation would have been indicated in 108 (8.6) patients, but only 29 (27) of these were correctly identified by the attending cardiologist (K statistics for agreement for indications 0.06). Conclusion About a quarter of patients referred to cardiology departments for AF management have potential indications for non-pharmacological treatment according to the guidelines. Substrate catheter ablation was offered by the attending cardiologist in a percentage similar to that expected, but concordance with guideline indications was moderate. Atrioventricular junction ablation and pace-maker implantation was largely underused. Published on behalf of the European Society of Cardiology. © The Author 2010.
2010
Atrial fibrillation; Guidelines; Rhythm-control; Rate-control
Bottoni, N; Tritto, M; Ricci, R; Accogli, M; Di Biase, M; Iacopino, S; Iori, M; Themistoclakis, S; Sitta, N; Spadacini, G; DE PONTI, Roberto; Brignole, M.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11383/1745919
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