Grant: Operating Grant

Atrial fibrillation (AF) is the most common sustained rhythm disorder of the heart. It is characterized by an irregular and difficult to control heart rate that can lead to stroke, heart failure, and an increased mortality, notwithstanding the morbidity associated with symptomatic palpitations and hospitalizations. The lifetime risk of developing AF in individuals 40 years and older is 1 in 4, with the risk increasing with age, and other risk factors such as diabetes, high blood pressure, and underlying heart disease. Alarmingly, the prevalence is projected to double in the next 50 years. The optimal management of AF remains a source of controversy. Although medical therapy has long been regarded as the mainstay of treatment, the drugs we use to treat AF may in fact cause more harm than good. Catheter ablation for AF has emerged as a promising new strategy for the management of AF. AF ablation is a non-surgical procedure that uses radiofrequency or cryo-energy to disrupt abnormal connections within the heart. This new strategy has seen a tremendous increase in use over the last 10 years, however long term data on the relative safety and benefits of AF ablation procedures compared to use of medication are lacking. In order to address these important issues, we propose to conduct an evaluation of catheter ablation in patients with AF in Quebec, Ontario and British Columbia. We will describe and compare the utilization of AF ablation between the Canadian provinces, evaluate its safety, define the optimal use of adjunctive medications to prevent stroke, and estimate the healthcare resource utilization associated with this new therapy. Given the growing use of AF ablation in the last 10 years, the rapidly increasing prevalence of AF, and the already known devastating consequences of this disease, it is imperative that we understand the long-term risks and benefits of this relatively new procedure.