Data / Registries

A worldwide survey on incidence, management, and prognosis of oesophageal fistula formation following atrial fibrillation catheter ablation: the POTTER-AF study

Data/Registries: Aims: Oesophageal fistula represents a rare but dreadful complication of atrial fibrillation catheter ablation. Data on its incidence, management, and outcome are sparse. Methods and results: This international multicentre registry investigates the characteristics of oesophageal fistulae after treatment of atrial fibrillation by catheter ablation. A total of 553 729 catheter ablation procedures (radiofrequency: 62.9%, cryoballoon: 36.2%, other modalities: 0.9%) were performed, at 214 centres in 35 countries. In 78 centres 138 patients [0.025%, radiofrequency: 0.038%, cryoballoon: 0.0015% (P < 0.0001)] were diagnosed with an oesophageal fistula. Peri-procedural data were available for 118 patients (85.5%). Following catheter ablation, the median time to symptoms and the median time to diagnosis were 18 (7.75, 25; range: 0–60) days and 21 (15, 29.5; range: 2–63) days, respectively. The median time from symptom onset to oesophageal fistula diagnosis was 3 (1, 9; range: 0–42) days. The most common initial symptom was fever (59.3%). The diagnosis was established by chest computed tomography in 80.2% of patients. Oesophageal surgery was performed in 47.4% and direct endoscopic treatment in 19.8% and conservative treatment in 32.8% of patients. The overall mortality was 65.8%. Mortality following surgical (51.9%) or endoscopic treatment (56.5%) was significantly lower as compared to conservative management (89.5%) [odds ratio 7.463 (2.414, 23.072) P < 0.001]. Conclusion: Oesophageal fistula after catheter ablation of atrial fibrillation is rare and occurs mostly with the use of radiofrequency energyrather than cryoenergy. Mortality without surgical or endoscopic intervention is exceedingly high.

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Patient in Room to Physician in Room

Data/Registries: This sample report shows performance over time of patient in room compared to physician in room and  patient in room access compared to when the patient arrives in the lab.

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Quality Tracking Tool – Lab Efficiency

Data/Registries: This spreadsheet can be used to track procedure times in the EP lab. Once compiled into a database, reporting can be provided to stakeholders each month with physician times.

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AHA’s Get With The Guidelines® – AFIB Registry Tool

Guidelines/Clinical Documents: AHA’s Get With The Guidelines® – AFIB Registry Tool

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Rationale, considerations, and goals for atrial fibrillation centers of excellence: A Heart Rhythm Society perspective

Guidelines/Clinical Documents: This manuscript builds on the work of a diverse, multiple-stakeholder Think Tank meeting and multidisciplinary Inter-pro Forum educational activity held in January 2019, both led by the Heart Rhythm Society (HRS). When examining the current clinical landscape, the Think Tank concluded that there is a clear need for AF CoEs to improve AF care and its delivery. In this manuscript, HRS hopes to accelerate this evolution by reviewing the rationale for AF CoEs, the available evidence for integrated and multidisciplinary care, and future challenges and opportunities. The document also defines the key priorities to be used as a guide for HRS and its diverse stakeholders to build consensus on defining the core components of an AF CoE.

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Harmonized outcome measures for use in atrial fibrillation patient registries and clinical practice

The purpose of this project was to develop a minimum set of standardized outcome measures that could be collected in AF patient registries and clinical practice.

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Biomedical Imaging and Intervention Journal

Care Pathways/CDS: This article describes the results of a transition-of-care protocol that was developed to improve guideline-based oral anticoagulant management in the emergency department of a medical center located in an under-served San Diego community. This article also describes treatment gaps in prescribing oral anticoagulants for patients with non-valvular atrial fibrillation at risk for stroke in the emergency department.

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