Nationwide survey of catheter ablation for atrial fibrillation: The Japanese Catheter Ablation Registry of Atrial Fibrillation (J-CARAF) – Report on antiarrhythmic drug therapy

BackgroundThe Japanese Heart Rhythm Society (JHRS) conducted a nationwide survey of catheter ablation of atrial fibrillation (AF) in Japan, the Japanese Catheter Ablation Registry of Atrial Fibrillation (J-CARAF). In this report, to offer a perspective on the current status of hybrid AF therapy, we focus on antiarrhythmic drug (AAD) therapy before and after AF ablation.MethodsThe JHRS requested electrophysiology centers in Japan to retrospectively register the comprehensive data of each AF ablation session performed in September 2011, March 2012, or September 2012.ResultsA total of 179 EP centers submitted data for 3373 sessions. The average patient age was 62.2±10.6 years, and 76.1% (2587) were male. Patients with paroxysmal AF (PAF) consisted of 64.4% of total patients. The average number of AADs used before AF ablation was 1.13±0.96. Among 2173 PAF patients, 454 subjects (20.9%) underwent AF ablation without preceding AAD therapy.At the time of discharge, 40.3% of PAF patients were given one or more AAD, while 63.0% of persistent AF patients and 71.5% of long-standing-persistent AF patients left the hospital with an AAD (p<0.0001). Bepridil was most frequently prescribed (17.4%), specifically in non-PAF patients (PAF 10.5% vs. non-PAF 30.3%, p<0.0001). Amiodarone was used in 5.8% of the patients. Among 148 subjects (4.5%) treated with multiple AADs, 131 were taking bepridil.ConclusionsApproximately 20% of PAF ablations were performed without preceding AAD therapy. The post-procedural AAD regimen was appreciably dependent on the AF type.