Abstract
The Japanese Catheter Ablation (J‐AB) registry, started in August 2017, is a voluntary, nationwide, multicenter, prospective, observational registry, performed by the Japanese Heart Rhythm Society (JHRS) in collaboration with the National Cerebral and Cardiovascular Center using a Research Electronic Data Capture system. The purpose of this registry is to collect the details of target arrhythmias, the ablation procedures, including the type of target arrhythmias, outcomes, and acute complications in the real‐world settings. During the year of 2021, we have collected a total of 89 609 procedures (mean age of 66.1 years and 65.9% male) from 506 participant hospitals. Detailed data are shown in Figures and Tables.
Keywords: catheter ablation, complication, J‐AB, REDCap, registry
AF ablation is the leading procedure and is gradually increasing.
Catheter ablation has become an established therapy for the management of various cardiac arrhythmias and the procedure number has been dramatically increasing. However, little is known about the details of target arrhythmias, the ablation procedures, including the type of target arrhythmias, outcomes, and acute complications in the real‐world settings.
There are several preceding registries of catheter ablation, but the majority of which collected data from selected centers and/or selected arrhythmia and/or specified months to reveal the current status of ablations. 1 , 2 , 3 Accordingly, we conducted a nationwide, multicenter. prospective, observational registry in Japan, named Japanese Catheter Ablation (J‐AB) registry, aiming to register all catheter ablation cases in Japan. 4 This registry has been performed by the Japanese Heart Rhythm Society (JHRS) in collaboration with the National Cerebral and Cardiovascular Center using a Research Electronic Data Capture (REDCap) system. This study has been performed under the approval from the Institutional Review Board (IRB) of the National Cerebral and Cardiovascular Center (M28‐114‐7, approved at Dec 21, 2016), Japan, along with the IRBs of all participating hospitals. All participants were provided the informed consent either by a written paper or by an optout fashion and could withdraw their consent at any time. This study was also registered in the UMIN Clinical Trial Registry (UMIN 000028288) and ClinicalTrials.gov (NCT03729232). This J‐AB registry started in August 2017, since then the number of participating hospitals has increased to over 400 at the end of 2019. Annual data during the year of 2018, 2019, and 2020 have been already reported, 5 , 6 , 7 and now, we report here the annual report of the results during the year of 2021. Figure 1 shows that the cumulative number of registered hospitals and the patients during the year of 2021. Figure 2 shows that the number and rate of the target arrhythmias. AF ablation was the leading procedure (75.0% of all ablation procedures) in 2021, and the percentage of patients over 75 years of age was 28.3% in 2021. Patient characteristics, acute outcomes, and acute complications of all and AF procedures are shown in Tables 1, 2, 3, respectively.
FIGURE 1.
Cumulative number of registered hospitals (red line) and the patients (blue bars) during the year of 2021.
FIGURE 2.
The number and rate of the target arrhythmias in the J‐AB registry 2021 (89 609 procedures; A) and 2020 (84 591 procedures; B). AF, atrial fibrillation; AFL, atrial flutter; AT, atrial tachycardia; AVNRT, atrioventricular nodal reentrant tachycardia; AVRT, atrioventricular reentrant tachycardia; IVC, inferior vena cava; PVC, premature ventricular contraction; TV, tricuspid valve; VT, ventricular tachycardia.
TABLE 1.
Patient characteristics.
| All procedures | Atrial fibrillation (AF) | Atrial flutter (AFL)/atrial tachycardia (AT) | Atrioventricular nodal reentrant tachycardia | Atrioventricular reentrant tachycardia | Premature ventricular contraction | Ventricular tachycardia (VT) | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| All AF | Paroxysmal AF (PAF) | Non‐PAF | All AFL/AT | IVC‐TV isthmus dependent AFL | Uncommon AFL/macro AT | Focal AT | Idiopathic VT | VT because of ischemic cardiomyopathy | VT because of nonischemic cardiomyopathy | VT because of CHD | |||||
| N | 89 609 | 67 188 | 37 467 | 28 844 | 15 395 | 9605 | 3957 | 2894 | 6467 | 2753 | 4314 | 778 | 459 | 570 | 21 |
| Age, mean ± SD | 66.1 ± 13.2 | 67.8 ± 10.8 | 67.9 ± 11.1 | 67.7 ± 10.3 | 68.8 ± 12.7 | 69.0 ± 11.9 | 70.4 ± 12.0 | 66.2 ± 15.8 | 59.1 (16.7) | 48.4 (20.5) | 57.9 (16.7) | 55.8 (18.7) | 69.8 (9.5) | 64.6 (12.7) | 46.5 (17.4) |
| Gender, male | 59 019 (65.9%) | 46 127 (68.7%) | 24 254 (64.7%) | 21 281 (73.8%) | 10 415 (67.7%) | 7313 (76.1%) | 2294 (58.0%) | 1395 (48.2%) | 2682 (41.5%) | 1788 (64.9%) | 2402 (55.7%) | 530 (68.1%) | 417 (90.8%) | 463 (81.2%) | 18 (85.7%) |
| Heart diseases | 20 209 (22.6%) | 14 709 (21.9%) | 7055 (18.8%) | 7555 (26.2%) | 5121 (33.3%) | 3093 (32.2%) | 1821 (46.0%) | 816 (28.2%) | 558 (8.6%) | 201 (7.3%) | 862 (20.0%) | 175 (22.5%) | — | — | — |
| IHD | 6853 (7.6%) | 5048 (7.5%) | 2820 (7.5%) | 2184 (7.6%) | 1455 (9.5%) | 993 (10.3%) | 382 (9.7%) | 182 (6.3%) | 189 (2.9%) | 68 (2.5%) | 311 (7.2%) | 54 (6.9%) | — | 36 (6.3%) | 0 (0%) |
| Cardiomyopathy | 6001 (6.7%) | 4418 (6.6%) | 1562 (4.2%) | 2828 (9.8%) | 1300 (8.4%) | 784 (8.2%) | 444 (11.2%) | 221 (7.6%) | 79 (1.2%) | 38 (1.4%) | 341 (7.9%) | 62 (8.0%) | 13 (2.8%) | — | 1 (4.8%) |
| Valve disease | 3642 (4.1%) | 2332 (3.5%) | 1002 (2.7%) | 1292 (4.5%) | 1536 (10.0%) | 775 (8.1%) | 749 (18.9%) | 236 (8.2%) | 90 (1.4%) | 18 (0.7%) | 118 (2.7%) | 31 (4.0%) | 29 (6.3%) | 44 (7.7%) | 1 (4.8%) |
| CHD | 1130 (1.3%) | 570 (0.8%) | 309 (0.8%) | 261 (0.9%) | 581 (3.8%) | 341 (3.6%) | 266 (6.7%) | 119 (4.1%) | 37 (0.6%) | 39 (1.4%) | 20 (0.5%) | 6 (0.8%) | 0 (0%) | 2 (0.4%) | — |
Abbreviations: CHD, congenital heart disease; IHD, ischemic heart disease; SD, standard deviation.
TABLE 2.
Acute outcomes.
| 2021 | 2020 | 2021–2020 | |
|---|---|---|---|
| n (%) | n (%) | % change | |
| Pulmonary vein isolation of atrial fibrillation (n = 64 922) | n = 61 757 | ||
| Ablation system | |||
| RF alone | 47 474 (73.12%) | 47 022 (76.14%) | −3.02% |
| Ballon alone (Cryo, hot, laser) | 12 212 (18.81%) | 9953 (16.12%) | +2.69% |
| RF + Ballon combination | 4979 (7.67%) | 4419 (7.16%) | +0.51% |
| Others | 417 (0.64%) | 172 (0.28%) | +0.36% |
| Missing | 33 (0.05%) | 191 (0.31%) | −0.26% |
| Patient with a first session | 53 113 | 50 193 | |
| Success | 52 707 (99.24%) | 49 881 (99.38%) | −0.14% |
| Unsuccess | 279 (0.53%) | 240 (0.48%) | +0.05% |
| Unknown | 127 (0.24%) | 72 (0.14%) | +0.10% |
| Patient with second session | 9623 | 9511 | |
| Success | 7609 (79.07%) | 7688 (80.83%) | −1.76% |
| Unsuccess | 13 (0.14%) | 20 (0.21%) | −0.07% |
| Already isolated | 1950 (20.26%) | 1756 (18.46%) | +1.80% |
| Unknown | 51 (0.53%) | 47 (0.49%) | +0.04% |
| Patient with ≥third session | 2186 | 2053 | |
| Success | 1226 (56.08%) | 1191 (58.01%) | −1.93% |
| Unsuccess | 3 (0.14%) | 6 (0.29%) | −0.15% |
| Already isolated | 948 (43.37%) | 850 (41.40%) | +1.97% |
| Unknown | 9 (0.41%) | 6 (0.29%) | +0.12% |
| IV‐TV isthmus dependent atrial flutter (n = 9605) | n = 9612 | ||
| Success | 9532 (99.24%) | 9544 (99.29%) | −0.05% |
| Unsuccess | 71 (0.74%) | 66 (0.69%) | +0.05% |
| Unknown | 2 (0.02%) | 2 (0.02%) | +0.00% |
| Uncommon atrial flutter/ atrial tachycardia (n = 3957) | n = 3746 | ||
| Complete success | 3392 (85.72%) | 3198 (85.37%) | +0.35% |
| Partial success | 366 (9.25%) | 356 (9.50%) | −0.25% |
| Unsuccess | 135 (3.41%) | 145 (3.87%) | −0.46% |
| Unknown | 64 (1.62%) | 47 (1.25%) | +0.37% |
| Focal atrial tachycardia (n = 2894) | n = 2814 | ||
| Complete success | 2438 (84.24%) | 2354 (83.65%) | +0.59% |
| Partial success | 319 (11.02%) | 311 (11.05%) | −0.03% |
| Unsuccess | 106 (3.66%) | 107 (3.80%) | −0.14% |
| Unknown | 31 (1.07%) | 42 (1.49%) | −0.42% |
| Atrioventricular nodal reentrant tachycardia by slow–fast (n = 5534) | n = 5247 | ||
| Complete success | 5418 (97.90%) | 5127 (97.71%) | +0.19% |
| Partial success | 80 (1.45%) | 74 (1.41%) | +0.04% |
| Unsuccess | 21 (0.38%) | 32 (0.61%) | −0.23% |
| Unknown | 15 (0.27%) | 14 (0.27%) | +0.00% |
| Atrioventricular nodal reentrant tachycardia by fast‐slow (n = 573) | n = 531 | ||
| Complete success | 542 (94.59%) | 502 (94.54%) | +0.05% |
| Partial success | 17 (2.97%) | 24 (4.52%) | −1.55% |
| Unsuccess | 10 (1.75%) | 2 (0.38%) | +1.37% |
| Unknown | 4 (0.70%) | 3 (0.56%) | +0.14% |
| Atrioventricular nodal reentrant tachycardia by slow–slow (n = 356) | n = 326 | ||
| Complete success | 341 (95.79%) | 314 (96.32%) | −0.53% |
| Partial success | 10 (2.81%) | 7 (2.15%) | +0.66% |
| Unsuccess | 2 (0.56%) | 3 (0.92%) | −0.36% |
| Unknown | 3 (0.84%) | 2 (0.61%) | +0.23% |
| Atrioventricular nodal reentrant tachycardia by other (n = 102) | n = 103 | ||
| Complete success | 85 (83.33%) | 86 (83.50%) | −0.17% |
| Partial success | 9 (8.82%) | 10 (9.71%) | −0.89% |
| Unsuccess | 2 (1.96%) | 3 (2.91%) | −0.95% |
| Unknown | 6 (5.88%) | 4 (3.88%) | +2.00% |
| Atrioventricular reentrant tachycardia by kent (n = 2670) | n = 2672 | ||
| Complete success | 2586 (96.85%) | 2589 (96.89%) | −0.04% |
| Unsuccess | 65 (2.43%) | 68 (2.54%) | −0.11% |
| Unknown | 19 (0.71%) | 15 (0.56%) | +0.15% |
| Premature ventricular contraction (n = 4314) | n = 3949 | ||
| Complete success | 3340 (77.42%) | 3031 (76.75%) | +0.67% |
| Partial success | 645 (14.95%) | 658 (16.66%) | −1.71% |
| Unsuccess | 247 (5.73%) | 216 (5.47%) | +0.26% |
| Unknown | 82 (1.90%) | 44 (1.11%) | +0.79% |
| Idiopathic ventricular tachycardia (n = 778) | n = 806 | ||
| Complete success | 616 (79.18%) | 628 (77.92%) | +1.26% |
| Partial success | 126 (16.20%) | 134 (16.63%) | −0.43% |
| Unsuccess | 25 (3.21%) | 28 (3.47%) | −0.26% |
| Unknown | 11 (1.41%) | 16 (1.98%) | −0.57% |
| Ventricular tachycardia because of ischemic cardiomyopathy (n = 459) | n = 486 | ||
| Complete success | 320 (69.72%) | 342 (70.37%) | −0.65% |
| Partial success | 97 (21.13%) | 111 (22.84%) | −1.71% |
| Unsuccess | 24 (5.23%) | 21 (4.32%) | +0.91% |
| Unknown | 18 (3.92%) | 12 (2.47%) | +1.45% |
| Ventricular tachycardia because of nonischemic cariomyopathy (n = 570) | n = 544 | ||
| Complete success | 338 (59.30%) | 295 (54.23%) | +5.07% |
| Partial success | 165 (28.95%) | 177 (32.54%) | −3.59% |
| Unsuccess | 37 (6.49%) | 48 (8.82%) | −2.33% |
| Unknown | 30 (5.26%) | 24 (4.41%) | +0.85% |
| Ventricular tachycardia because of CHD (n = 21) | n = 18 | ||
| Complete success | 18 (85.71%) | 15 (83.33%) | +2.38% |
| Partial success | 2 (9.52%) | 2 (11.11%) | −1.59% |
| Unsuccess | 1 (4.76%) | 1 (5.56%) | −0.80% |
Abbreviations: CHD, congenital heart disease; IVC, inferior vena cava; RF, radiofrequency ablation; TV, tricuspid valve.
TABLE 3.
Acute complications.
| N | 2021 | 2020 | 2021–2020 All patient | % change AF | ||
|---|---|---|---|---|---|---|
| All patient | AF | All patient | AF | |||
| 88 880 | 66 599 | 84 591 | 63 096 | |||
| Complications during hospitalization | 2088 (2.35%) | 1680 (2.52%) | 1992 (2.35%) | 1578 (2.50%) | 0% | +0.02% |
| Major bleeding (BARC ≧ 2) | 813 (0.91%) | 622 (0.93%) | 776 (0.92%) | 567 (0.90%) | −0.01% | +0.03% |
| Cardiac tamponade | 473 (0.53%) | 333 (0.50%) | 490 (0.58%) | 335 (0.53%) | −0.05% | −0.03% |
| Embolism | 151 (0.17%) | 130 (0.20%) | 141 (0.17%) | 126 (0.20%) | 0% | 0% |
| Phrenic nerve paralysis | 261 (0.29%) | 254 (0.38%) | 254 (0.30%) | 245 (0.39%) | −0.01% | −0.01% |
| Esophagus | 129 (0.15%) | 126 (0.19%) | 99 (0.12%) | 98 (0.16%) | +0.03% | +0.03% |
| Esophagus ulcer | 15 (0.02%) | 13 (0.02%) | 19 (0.02%) | 19 (0.03%) | 0% | −0.01% |
| Gastric hypomotility | 116 (0.13%) | 115 (0.17%) | 82 (0.10%) | 81 (0.13%) | +0.03% | +0.04% |
| Atrioesophageal fistula | 0 (0.00%) | 0 (0.00%) | 0 (0.00%) | 0 (0.00%) | 0% | 0% |
| Pericardities | 101 (0.11%) | 79 (0.12%) | 110 (0.13%) | 91 (0.14%) | −0.02% | −0.02% |
| Sick sinus syndrome | 179 (0.20%) | 144 (0.22%) | 152 (0.18%) | 117 (0.19%) | +0.02% | +0.03% |
| Atrioventricular block | 96 (0.11%) | 31 (0.05%) | 68 (0.08%) | 26 (0.04%) | +0.03% | +0.01% |
| Death during hospitalization | 93 (0.10%) | 43 (0.06%) | 92 (0.11%) | 33 (0.05%) | −0.01% | +0.01% |
| Cardiac death | 43 (0.05%) | 16 (0.02%) | 54 (0.06%) | 14 (0.02%) | −0.01% | 0% |
| Related to ablation therapy | 1 (0.001%) | 1 (0.002%) | 3 (0.004%) | 0 (0%) | 0% | 0% |
| Non cardiac death | 49 (0.06%) | 26 (0.04%) | 38 (0.04%) | 19 (0.03%) | +0.02% | +0.01% |
| Related to ablation therapy | 1 (0.001%) | 1 (0.002%) | 2 (0.002%) | 2 (0.003%) | 0% | 0% |
FUNDING INFORMATION
Japanese Heart Rhythm Society.
CONFLICT OF INTEREST STATEMENT
Kengo Kusano: Speaker honoraria from DAIICHI SANKYO COMPANY, Ltd., Bayer Yakuhin, and Medtronic Japan, and research grants from Medtronic Japan, HITACHI, and JSR.
Teiichi Yamane: Speaker honoraria from Medtronic Japan, and BEG, and research grants from Japan Lifeline.
Koichi Inoue: Speaker honoraria from DAIICHI SANKYO COMPANY, Ltd., Bristol Myers Squibb, Bayer Yakuhin, Nippon Boehringer Ingelheim, Johnson & Johnson KK, Medtronic Japan, and Boston Scientific Japan.
Koji Miyamoto received research fundings irrelevant to this study from Abbott, Japan Lifeline, Boston and lecture fees from Abbott, Nihon‐koden, Johnson & Johnson KK, Medtronic Japan, DAIICHI SANKYO COMPANY, Ltd., Brystol Myer Squibb, Pfizer, Bayer Yakuhin.
Seiji Takatsuki received research fundings irrelevant to this study from Nippon Boehringer Ingelheim, Japan Lifeline, Eizai, Boston Scientific Japan, Johnson & Johnson KK and lecture fees from Medtronic Japan, Japan Lifeline, DAIICHI SANKYO COMPANY, Ltd., Pfizer, Boston Scientific Japan, Bayer Yakuhin, Biotronik Japan, Nippon Boehringer Ingelheim, Brystol Myers Squibb, Nihon‐koden.
Wataru Shimizu: Research grant from DAIICHI SANKYO COMPANY, Ltd., and Nippon Boehringer Ingelheim, and Speaker honoraria from DAIICHI SANKYO COMPANY, Ltd., Bristol Myers Squibb, Bayer Yakuhin, Nippon Boehringer Ingelheim, Ono Pharmaceutical Co, Ltd, Pfizer, Novartis Pharma K.K., and Medtronic Japan.
None: M.T., M.K, M.N, K.K, R.T, Y.I, K.N.
ETHICS STATEMENT
This study was approved from the Institutional Review Board (IRB) of the National Cerebral and Cardiovascular Center (M28‐114‐7, approved at December 21, 2016), Japan, along with the IRBs of all participating hospitals.
ACKNOWLEDGMENTS
The authors are grateful for the contributions of all the investigators and Yoko Sumida for the data management in the J‐AB registry.
Kusano K, Yamane T, Inoue K, Takegami M, Nakai M, Kanaoka K, et al. The Japanese Catheter Ablation Registry (J‐AB): Annual report in 2021. J Arrhythmia. 2023;39:853–859. 10.1002/joa3.12931
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