Temporal changes in patient characteristics and prior pharmacotherapy in patients undergoing radiofrequency ablation of atrial fibrillation: a Danish nationwide cohort study

Trends in patient selection and pharmacotherapy before radiofrequency ablation (RFA) of atrial fibrillation are not well studied. We examined temporal trends in RFA utilization on a nationwide scale in Denmark.

Using the cross-linkage of nationwide registers, 3302 atrial fibrillation patients treated with ‘first-ever’ RFA between 2000 and 2009 were identified. Median age was 59 years (interquartile range 53–65) and 73.8% were males. From 2000–01 to 2008–09 the median age increased from 55 (48–61) to 61 (55–66) years (P < 0.0001). The proportion of patients with hypertension and diabetes mellitus increased from 34.8 to 50.6% (P < 0.0001) and 2.2 to 5.9% (P < 0.01), respectively. The proportion of patients with heart failure, vascular disease or previous stroke remained unchanged. The percentage of patients with CHA₂DS₂-VASc score ≥2 increased from 23.9 to 41.5% (P < 0.0001). The proportion of patients who did not receive any class Ic or class III antiarrhythmic drugs (AADs) within 2 years prior to ‘first-ever’ RFA increased from 8.7 to 22.7% (P < 0.0001). Prior use of sotalol and class Ic AADs decreased from 63 to 6.3% (P < 0.0001) and from 35 to 24% (P < 0.0001), respectively. Amiodarone and beta-blockers prior to RFA were used in 36 and 82% of all patients, respectively, without significant temporal changes.

During a 10-year period, RFA was increasingly performed in older patients with higher co-morbidity, and without prior trial of antiarrhythmic therapy. These findings may provide a framework to understand the outcomes of RFA.