33333
NATIONAL AUDIT OF
CARDIAC ABLATION
2013-14
1
NICOR (National Institute for Cardiovascular Outcomes Research) is a
research partnership of clinicians, IT experts, statisticians, academics
and managers which manages six cardiovascular clinical audits and a
growing portfolio of new health technologies, including the UK TAVI
registry. NICOR analyses and disseminates information about clinical
practice in order to drive up the quality of care and outcomes for
patients.
The British Cardiovascular Society promotes education, training and
research in cardiovascular health and upholds clinical and professional
standards.
The British Heart Rhythm Society (formerly Heart Rhythm UK) is an
affiliated group of the British Cardiovascular Society and the
Arrhythmia Alliance, and is dedicated to improving all aspects of
cardiac arrhythmia care and electrical device based therapies. It
provides an essential link between professionals working within
pacing, devices and electrophysiology in the UK.
The Cardiac Ablation audit is commissioned by the Healthcare Quality
Improvement Partnership (HQIP) as part of the National Audit of
Cardiac Rhythm Management and is one of the Clinical Outcome
Review Programmes. HQIPs aim is to promote quality improvement
and is led by a consortium of the Academy of Medical Royal Colleges,
the Royal College of Nursing and National Voices.
The Clinical Outcome Review Programmes, which encompasses
confidential enquiries, are designed to help assess the quality of
healthcare, and stimulate improvement in safety and effectiveness’s
by systematically enabling clinicians, managers and policy makers to
learn from adverse events and adverse data.
Founded in 1826, UCL (University College London) was the first
English university established after Oxford and Cambridge, the first to
admit students regardless of race, class, religion or gender, and the
first to provide systematic teaching of law, architecture and medicine.
It is among the world’s top universities, as reflected by performance
in a range of international rankings and tables. UCL currently has
almost 29,000 students from 150 countries and more than 10,000
employees. Its annual income is over £900 million.
2
1. Prelude
1.1 Acknowledgements
The National Cardiac Rhythm Management Ablation Audit is managed by the National Institute for
Cardiovascular Outcomes Research (NICOR), which is part of the National Centre for Cardiovascular
Prevention and Outcomes, based at University College London. Specialist clinical knowledge and leadership
is provided by the British Cardiovascular Society and British Heart Rhythm Society. The strategic direction
and development of the audit is determined by the Audit Steering Group. This includes major stakeholders
in the audit, including cardiologists, the professional societies, physiologists, commissioners and patient
group representatives.
We would especially like to thank the contribution of all NHS Trusts and the individual physiologists,
clinicians and audit teams who collect data and participate in the audit. Without this input the audit could
not continue to produce credible analysis, or to effectively monitor and assess the standard of care in the
UK.
1.2 Authors
This report was produced by:
Michael Griffith
Lead author (co-opted by British Heart Rhythm Society)
Francis Murgatroyd
BHRS Clinical Audit Lead
Nick Linker
President, BHRS
David Cunningham
Senior Strategist, NICOR
Morag Cunningham
CRM Database Coordinator, NICOR
Anthony Bradley
Project Manager, NICOR
Linda Chadburn
Audit and Research Manager, NICOR
Andrew Hughes
Public Health England (for the creation of the maps)
This report is available online at www.ucl.ac.uk/nicor/audits/cardiacrhythmmanagement/publicreports
and www.BHRS.com/audit
1.3 Contact Details
This report contains information on device implantation by hospitals in England and Wales. For further
information or queries please contact the following:
NICOR Technical Support Help Desk
Tel: 020 3108 1978 e-mail: nicor-helpdesk@ucl.ac.uk
Information and assistance for
participating hospitals
Morag Cunningham – CRM Audit
Database Coordinator
General Enquiries
Anthony Bradley - CRM Audit Project
Manager
Tel: 01505 612829 e-mail: morag.cunningham@ucl.ac.uk
Tel: 020 3108 3926 e-mail: a.j.bradley@ucl.ac.uk
Published 27 March 2015
The contents of this report may not be published or used commercially without permission.
3
Contents
1. Prelude
3
1.1 Acknowledgements
3
1.2 Authors
3
1.3 Contact Details
3
2. Executive Summary
5
3. Introduction from the National Clinical Director
6
4. Aims and objectives of the audit
7
5. Methodology
7
5.1 Organisation of the audit
7
5.2 Data collection and IT
7
5.3 The future of the audit
8
10
6. Findings
6.1 Overview of ablation in the UK - National Implant Rate Trends
10
6.2 All ablation targets by year
10
6.3 Geographic rates of atrial fibrillation ablation procedures
12
6.4 Regional ablation rates – all targets
16
6.5 Regional ablation rates – AF Ablation
18
6.6 European implant rates 2013
25
6.7 Number and Type of Atrial Fibrillation Ablation procedures
27
6.8 Ablation targets per procedure by hospital
31
6.9 Data quality for key fields
34
7. Conclusions
38
8. Hospital Reports
39
4
2. Executive Summary
Catheter ablation is a technique for treating (and usually curing) heart rhythm disturbances
(arrhythmias), using fine, flexible electrodes threaded into the heart via veins. These are used to
make small burns that eliminate the abnormal tissue responsible for the arrhythmias. The
technique first appeared 25 years ago, principally for the elimination of supraventricular
tachycardias (SVTs - arrhythmias caused by extra connections in the heart). More recently, it has
become an important treatment for symptoms in patients with arrhythmias arising from the upper
chambers of the heart - chiefly atrial fibrillation (AF) and flutter, which often do not respond well
to drugs.
A registry of catheter ablation procedures was created ten years ago by the precursor of the
British Heart Rhythm Society, and it is now jointly run by BHRS and NICOR. This is the 9th UK
Ablation Report, covering ablation for cardiac arrhythmias in the financial year 2013/14, and giving
trends over preceding (calendar) years. The data are based on returns from around 60 NHS and
private centres that that undertake catheter ablation in the UK. Submission to the national
database is a mandatory requirement in specialized commissioning by NHS England, and is
encouraged in Scotland, Wales and Northern Ireland.
Our principal findings are that the number of ablations performed in the UK increased significantly
between 2007 and 2010, but has remained static since. During that period, however, the
arrhythmias treated have changed, with SVTs now accounting for only 25% of cases. Two thirds of
ablations are for atrial arrhythmias, and AF ablation is now the single commonest
procedure. Around half of ablation procedures (including AF ablation) are “complex”, and require
more time than traditional procedures, as well as sophisticated 3D mapping technology, and
usually general anaesthesia and overnight hospitalization. Thus the static number of ablations
overall belies considerable changes in the actual amount of work undertaken, and consequent
resource implications.
The data demonstrate that ablation is under-provided in the UK compared to our immediate
Western European neighbours, and is even below the average for “greater” Europe. This parallels
the pattern seen with pacemakers and defibrillators. Within the UK, regional inequalities in the
provision of ablation has reduced somewhat over the last four years. However, a small number of
areas consistently have very low ablation rates while a few others are closer to that of Western
Europe. Among smaller centres, the proportion of ablations that are complex varies considerably.
This will be the last report based on the original national dataset, which was principally a registry
of procedures, and has become dated. From 1/4/14, a new dataset was mandated, which more
closely reflects modern and anticipated future practice, and information more relevant to
audit. We hope that this will in future include Patient Reported Outcome Measures to report
improvement in symptoms over 12 months as a key measure of both appropriate patient selection
and procedure success.
Finally, it is sadly clear to the authors that the completeness and quality of data returns are highly
variable, with some number of centres failing to report a proportion of cases altogether, and other
returning incomplete data. It is hoped that awareness of the importance (and indeed the
mandatory nature) of the audit, along with the new dataset, will result in even better reports in
future.
5
3. Introduction from National Clinical Director
I welcome publication of this, the 9th UK Cardiac Rhythm Management (CRM) Ablation Audit
Report, covering ablation for cardiac arrhythmias in the financial year 2013/14, and trends over
preceding years.
During 2013, much work has been undertaken to redesign and improve the CRM Audit and its
related Cardiac Devices Audit. Such work is time consuming and it is a pleasure to recognise the
important contributions made by those leading this work such as Francis Murgatroyd and Mike
Griffith for BHRS and David Cunningham and colleagues at NICOR. Their efforts have given us a
better record of cardiac ablation procedures undertaken in the UK. Complete and accurate data,
however, requires the sustained efforts of clinical physiologists, nurses and clinicians at ablation
centres. Their time is often unfunded, yet freely given, and all concerned also deserve our
recognition and thanks.
The results show that the total number of catheter ablation procedures in the UK, which rose
during the last decade, has been fairly static since 2010. A modest increase in AF ablation has
been seen in parallel with a decrease in the numbers of procedures for conventional
supraventricular tachycardias (SVTs), which now account for only 25% of all ablations. UK ablation
rates remain below those reported in some other European countries, as is the case for implanted
cardiac devices. Clinicians and commissioners are encouraged to follow best practice guidelines,
such as those published by the National Institute for Health & Care Excellence (NICE) and be alert
to any inequity in provision of these procedures.
It seems that a small number of centres are submitting incomplete data and may be omitting a
proportion of their cases. For information derived from clinical audits to be of greatest value, to
commissioners, providers, professionals and patients, it is vital that data collection is
comprehensive and accurate and I would urge all to contribute to, and strengthen, this registry.
This national CRM ablation audit continues to provide an essential tool for understanding current
practice, and how we might best plan for future improvement. As in previous years, I warmly
commend it to all who commission and deliver cardiac ablation therapy.
Huon Gray
Professor Huon Gray
National Clinical Director (Cardiac)
NHS England
6
4. Aims and objectives of the audit
The aim of the CRM Ablation Audit is to examine the procedure rates of all patients who undergo
cardiac ablation procedures in the UK.
The audit has the following objectives:




To collect data about all patients receiving interventional electrophysiology procedures for
management of cardiac rhythm disorders, in the UK.
To report activity, trends and outcomes in cardiac ablation practice in UK hospitals.
To continue to collect and develop the presentation of data from all ablation and
electrophysiology centres in the United Kingdom
To provide new analyses and outputs of the data as defined by the clinical group.
5. Methodology
5.1 Organisation of the audit
The audit is managed by the National Institute for Cardiovascular Outcomes Research (NICOR),
which is part of University College London (UCL). NICOR’s mission is to provide timely and accurate
data on cardiovascular outcomes for the public, healthcare providers and the medical profession.
The audit is commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of
the National Clinical Audit and Patient Outcomes Programme (NCAPOP).
The British Heart Rhythm Society (BHRS) provides clinical leadership through the Audit Steering
Group, which also includes representation from a wide range of other stakeholders and is cochaired by Dr Francis Murgatroyd and Dr Nick Linker.
5.2 Data collection and IT
Participating hospitals provide NICOR with audit data on procedure activity throughout the year.
Hospitals can either enter audit data manually via a dedicated interface or upload it from existing
hospital systems using commercial or locally developed software. All data uploaded is encrypted
on transmission and stored in encrypted form in NICOR’s central database.
All data held by NICOR are managed in a secure environment and in compliance with UCL’s
Information Governance and Security policies. NICOR is registered under the Data Protection Act
and has support under Section 251 of the National Health Service (NHS) Act 2006 to collect and
store patient identifiable data without explicit consent.
7
5.3 The future of the audit
This is the last annual audit based on the “old” national dataset, which has evolved over around a
decade. A new dataset has been designed after extensive stakeholder consultation (with doctors,
physiologists, specialist nurses, patient representatives, government bodies, and industry), and
became mandatory for procedures performed from 1 April 2014. This major revision will address
a number of issues:




A number of fields in the old dataset were obsolete or ambiguous
There is a need to include a number of new mapping and ablation technologies, and to
“future-proof” the dataset for future developments
An increasing proportion of ablation procedures are undertaken with complex substrates,
such as atrial fibrillation and ventricular tachycardia; their outcomes may be neither
“binary” nor clear at the end of the procedure (see below).
More relevant clinical detail of patients and their arrhythmias is required, especially
regarding AF ablations.
Finally, the old dataset was limited to catheter ablation procedures; the new dataset records all
invasive electrophysiologic procedures, including diagnostic EP studies, VT stimulation, and
internal cardioversion. Temporary pacing is excluded. In general, outcome measures from
procedures are either indicators of success or of complications.
Outcomes: Success
Historically, the national ablation dataset has included a field “ablation success”. This was relevant
in the early days of catheter ablation, when outcomes for conditions such as supraventricular
tachycardia and typical atrial flutter were clear-cut with very low recurrence rates. Acute abolition
of the substrate for these arrhythmias could generally be assumed to predict a permanent cure.
Conversely, any recurrence of these arrhythmias could be regarded as (early or late) treatment
failure.
There has been a great increase in more complex ablation procedures such as those for atrial
fibrillation and ventricular tachycardia, however, whose eventual outcomes are less binary and
may not be evident for weeks or months. Submitted “acute success” rates may therefore be
arbitrary and misleading – they have therefore not been included in this report, and it is
incumbent on us to seek more meaningful outcome measures.
Most ablation procedures, and especially AF ablation, are performed for the improvement of
symptoms. It is recognized that symptoms may be greatly diminished even eliminated without 100%
abolition of the causative arrhythmia. Early arrhythmia recurrence does not equate to long term
failure, and conversely late recurrence of AF is not uncommon. It follows that immediate procedural
outcome and short-term follow up is of limited value in establishing the outcome. AF recurrence over
a long term is very difficult to measure – a single ECG is of very little value, and some research
protocols require multiple 1-week ambulatory recordings - even permanently implanted ECG
recorders have been proposed. These measures are clearly not practical for a national audit.
In future, we therefore propose to measure symptom benefit using Patient Recorded Outcome
Measures (PROMs) – short questionnaires designed to assess disease specific symptoms and more
general quality of life. Patients will be asked to complete these questionnaires before and one
8
year after their ablation procedure, and one or more third party providers will collect and input
the data
NICE and NICOR have collaborated in retrospective and now prospective assessment of arrhythmia
PROMs, using simple questions, EQ5D5L, and a disease specific instrument. There is some
controversy about whether this exercise should be extended to all ablations, but in the
retrospective assessment, a significant benefit was shown for all arrhythmia substrates. However,
not all patients have a positive outcome, and the reasons for this are being assessed - it is likely to
be a combination of the patients selected, the success of the procedure, and probably to a lesser
extent the patient experience.
What would be the benefits be of measuring PROMs? If this exercise is funded, it may have some
immediate effect on patient selection, as patients who are truly asymptomatic will be unlikely to
benefit from an ablation. The change in PROMS will also over time allow more informed patient
selection to take place, with features suggesting a large or small benefit influencing and informing
the discussion with the patient before the procedure agreed. It is also possible that the process
will identify centres with particularly good or bad PROMs. This has not, however, been the case
with the hip/knee PROMs programme, possibly because of careful selection of patients by centres,
and possibly vice-versa. With hip and knee surgery in the UK, patients appear to get a very
uniform benefit, probably because they will not be offered surgery if minimally effected by their
arthritic joint. The symptomatic status of patients undergoing ablation is likely to be more varied.
Outcomes: Complications
Serious complications from catheter ablation are happily quite rare. They are also, unfortunately,
hard to measure. They may occur after hospital discharge (a high proportion of ablations are
performed as day cases) and present to hospitals other than the ablation centre. Some of the
most serious complications of AF ablation (pulmonary vein stenosis, phrenic palsy, atriooesophageal fistula) may not be evident for weeks or months after the procedure itself. Death has
been as an endpoint for many of the other national cardiac audits: it is “hard” and unequivocal,
and amenable to validation using OPCS data. However, it is less relevant for this audit. As with
cardiac device procedures, death and major adverse clinical events in the months following
ablation is rare and generally unrelated, being far more frequently attributable to the underlying
disease or comorbidity.
Reporting of complications is clearly very patchy, and indeed some cardiac software providers do not
currently even permit retrospective entry of a complication such as pneumothorax, once the
procedure report is “closed”. A centre reporting zero complications may be failing to submit for these
technical reasons, or may simply be unaware of complications presenting post-discharge. For this
reason, we are again not reporting submitted complications as we do not feel these reflect reality.
The new dataset, commencing in April 2014, has asked for immediate (i.e. noticed peri-procedure)
and late (3 months, or 12 months for AF ablation) to be reported. However, we recognize that
even this may be difficult, and we are therefore exploring the use of other sources to detect
possible outliers. These may include ONS data to look at death within (say) 3 months of AF
ablation procedures, or linkage with other national audits to detect myocardial infarction, stroke,
or re-intervention.
9
6. Findings
6.1 Overview of ablation in the UK – National Implant Rate Trends
Most ablation procedures target a single substrate (e.g. accessory pathway, pulmonary veins), but
some have multiple targets (e.g. pulmonary veins plus cavotricuspid isthmus for atrial fibrillation
and flutter).
Table 1 illustrates the total number of ablations for each target and the total number of ablation
procedures from 2007 to 2014 and these data are shown graphically in Figure 1; highlighting a
large increase in overall ablation procedures from 2007 to 2010, but very little change thereafter.
Table 1: All Ablation Procedures and Targets by Year
Ablation Target (Substrate)
2007
2008
2009
2010
2011
2012
2013-14
1. Sinus node ablation/modification
7
18
18
19
131
57
17
2. Atrial ectopics
13
28
57
58
43
48
42
3. Ectopic atrial tachycardia
221
370
426
490
476
547
595
4. Re-entrant atrial tachycardia
111
190
222
225
262
301
284
5. Atrial flutter (common type)
1,723
2,309
3,195
3,178
3,397
3,555
3,366
6. Atrial flutter (uncommon type)
185
293
406
418
427
438
533
7. Anterograde AV nodal modification in AFib
16
39
48
44
43
56
59
8. AV nodal fast pathway in AVNRT
19
18
22
26
36
37
31
9. AV nodal slow pathway in AVNRT
1,733
2,129
2,511
2,633
2,489
2,819
2,715
10. AV nodal fast/slow pathway in AVNRT
17
58
60
61
69
63
40
11. Concealed accessory pathway
549
610
676
644
567
602
668
12. Overt accessory pathway
635
826
897
970
939
948
894
13. Ventricular extrasystoles
105
174
251
287
294
350
399
14. Ventricular tachycardia
204
329
500
576
695
629
605
15. Atrial fibrillation (unspecified)
960
1,499
1,661
1,675
1,469
1,724
2,081
7
10
14
20
15
12
17
17. Complete AV nodal
418
594
714
975
884
1,064
1,002
18. Atrial fibrillation - PVI
553
850
1,670
1,949
1,963
2,247
2,449
19. Atrial fibrillation - LACA
676
957
1,800
2,053
2,216
2,160
1,913
-
-
-
-
-
-
9
99. Unlisted ablation
78
162
491
532
642
503
449
Unknown ablation target
282
557
311
422
486
598
513
All ablation procedures
8,035
11,273
14,827
15,734
16,061
17,166
17,106
All ablation targets
8,512
12,020
15,950
17,255
17,543
18,758
18,681
16. Atrio-fascicular (Mahaim) pathway
20. AVNRT (slow or fast pathway)
10
Fig 1: Ablations 2007-14
20,000
18,000
16,000
Total Ablations
Targets
14,000
12,000
10,000
8,000
6,000
4,000
2,000
0
2007
2008
2009
2010
2011
2012
2013-4
Some of the historic rise was due to increase in the ablation of Atrial Flutter (1,723 in 2007 to over
3000) and AV Nodal Slow Pathway in AVNRT (1,733 in 2007 to 2,633 in 2010). Another increase is
seen in the Atrial Fibrillation – PVI (553 in 2007 to 2,449 in 2013/14).
Concealed accessory pathway ablations remain very constant in number over this period. Overt
accessory pathway ablation remains fairly constant after 2008. Ablation procedures for ventricular
arrhythmias have tripled, but from a very low base (204 peaking at 695 in 2011).
6.2 All Ablation targets by year
Figure 2 illustrates the distribution of ablation targets from 2007 to 2013. Almost 65% of ablations
are performed for atrial arrhythmias, while supraventricular tachycardias account for 25%, with AV
node ablation and ventricular arrhythmias each accounting for only 5%.
Fig 2: Distribution of Ablation Targets by Year
11
6.3 Geographic variation in ablation rates (overall and for AF ablation)
The total catheter ablation rate per million population in the United Kingdom from 2010 to 2013 is
illustrated in figures 3, 4, 5 and 6 respectively.
Fig 3: Total Ablation Rate 2010
12
Fig 4: Total Ablation Rate 2011
13
Fig 5: Total Ablation Rate 2012
Fig 6: Total Ablation Rate 2013
14
15
6.4: Regional ablation rates – all targets
The breakdown of the numbers of targets and rates per million population by geographic area are
illustrated in table 2. These data are derived from patient postcode (>99% complete), rather than
the location of the centre performing the procedure.
As catheter ablation comes under specialized commissioning, data are grouped by Local Area
Team rather than Clinical Commissioning Groups or Cardiac Networks (as with prior audits).
TABLE 2: Regional ablation numbers and rates - all ablation targets
Ablation Targets
Channel Islands
England
(no LAT
allocated)
Isle of Man
Ablation Targets
per million population
Populatio 2007 2008 2009 2010 2011 2012 2013 200 200 200 201 201 201 201
n
7
8
9
0
1
2
3
168,000 11
29
21
24
24
30
39
65 173 125 143 143 179 232
371
257
154
348
304
356
326
86,000
4
32
28
56
40
30
37
47 372 326 651 465 349 430
1,814,300
12
16
33
53
64
54
69
7
687,937
53
95
150
225
171
140
165
77 138 218 327 249 204 240
57
58
77
74
91
90
159
1,221,746 103
207
328
555
444
445
548
84 169 268 454 363 364 449
1,176,033
52
200
222
269
373
415
481
44 170 189 229 317 353 409
2,715,618 710
771
677
687
801
671
361
261 284 249 253 295 247 133
1,460,893 198
265
306
347
433
350
437
136 181 209 238 296 240 299
Q48. Merseyside 1,187,152 27
224
384
771
462
402
451
23 189 323 649 389 339 380
Q49. Cumbria,
Northumberland
, Tyne and Wear
Q50. North
Yorkshire and
Humber
Q51. South
Yorkshire and
Bassetlaw
Q52. West
Yorkshire
Q53. Arden,
Herefordshire
and
Worcestershire
1,926,791 138
227
449
638
625
668
691
72 118 233 331 324 347 359
1,658,665 225
186
178
443
356
217
320
136 112 107 267 215 131 193
1,456,464 163
178
182
162
182
212
240
112 122 125 111 125 146 165
2,275,387 491
312
172
258
255
416
501
216 137
1,612,080 232
230
359
377
495
763
706
144 143 223 234 307 473 438
N Ireland
North Wales
Overseas
Q44. Cheshire,
Warrington and
Wirral
Q45. Durham,
Darlington and
Tees
Q46. Greater
Manchester
Q47. Lancashire
16
9
18
29
35
30
38
76 113 112 183 220
Ablation Targets
Q54.
2,419,500 280
Birmingham and
The Black
Country
Q55. Derbyshire 1,963,967 181
and
Nottinghamshire
Q56. East Anglia 2,424,901 29
240
292
357
590
912
931
Ablation Targets
per million population
116 99 121 148 244 377 385
216
340
354
394
355
386
92 110 173 180 201 181 197
594
1420
939
886
1004 1194
12 245 586 387 365 414 492
Q57. Essex
1,724,950 392
282
558
539
634
613
409
227 163 323 312 368 355 237
Q58.
Hertfordshire
and The South
Midlands
Q59.
Leicestershire
and Lincolnshire
Q60. Shropshire
and
Staffordshire
Q64. Bath,
Gloucestershire,
Swindon and
Wiltshire
Q65. Bristol,
North Somerset,
Somerset and
South
Gloucestershire
Q66. Devon,
Cornwall and
Isles Of Scilly
Q67. Kent and
Medway
Q68. Surrey and
Sussex
Q69. Thames
Valley
Q70. Wessex
2,643,386 381
482
887
881
918
975
975
144 182 336 333 347 369 369
1,731,350 280
368
514
520
527
589
604
162 213 297 300 304 340 349
1,570,267 220
205
237
261
380
517
546
140 131 151 166 242 329 348
1,458,129 191
229
337
359
375
451
314
131 157 231 246 257 309 215
1,423,539 176
203
370
212
122
176
145
124 143 260 149
1,668,218 178
380
503
483
434
454
430
107 228 302 290 260 272 258
1,727,665 246
676
1021
646
576
638
634
142 391 591 374 333 369 367
2,686,340 343 1045 1085 1314 1237 1245 1319
128 389 404 489 460 463 491
2,021,067 295
396
545
609
617
722
695
146 196 270 301 305 357 344
2,684,407 320
577
557
806
882
1038 1146
119 215 207 300 329 387 427
Q71. London
8,173,941 1188 1817 2918 2734 3147 2841 2446
145 222 357 334 385 348 299
Scotland
5,254,800 650
655
116
294
102
419
355
124 125
South Wales
2,375,519 258
319
461
579
467
447
463
109 134 194 244 197 188 195
11
10
14
8
11
57
Wales (no
network
allocated)
England (total)
3
53,012,456 7,41
0
22
56
86 124 102
19
80
68
10,76 14,99 15,86 16,44 17,44 17,23 140 203 283 299 310 329 325
7
5
9
9
5
6
17
Ablation Targets
Wales (total)
3,063,456
314
425
621
818
646
Ablation Targets
per million population
685 102 139 203 267 211 195 224
598
Significant inequalities are noted. In England the mean was 325 per million in 2013, but the range
was from 102 (Bristol) to over 490 per million (East Anglia and Surrey/Sussex).
6.5 Regional ablation rates - Atrial Fibrillation Ablation
As atrial fibrillation is now the commonest substrate for catheter ablation, this section explores
regional variation in this procedure. Table 3 and figures 7, 8, 9 and 10 illustrate the geographic
distribution of AF ablation rate per million population in 2010, 2011, 2012 and 2013 respectively
for the UK.
TABLE 3: Regional ablation numbers and rates – AF Ablation
AF Ablations
AF Ablations per million population
Population 2007 2008 2009 2010 2011 2012 2013 2007 2008 2009 2010 2011 2012 2013
Channel Islands
168,000
2
8
4
5
5
8
8
75
60
27
75
56
81
78
86,000
0
8
9
21
23
15
1,814,300
7
11
25
36
44
687,937 10
19
51
86
10
21
40
1,221,746 19
39
1,176,033 17
England
Isle of Man
N Ireland
North Wales
Overseas
12
48
24
30
30
48
48
20
0
93
105 244 267 174 233
30
53
4
6
14
20
24
17
29
79
59
70
15
28
74
125 115
86
102
33
37
36
45
98
189
172
194
234
16
32
80
155 141 159 192
58
56
88
125
129
146
14
49
48
75
106 110 124
Q44. Cheshire,
Warrington and
Wirral
Q45. Durham,
Darlington and Tees
Q46. Greater
Manchester
Q47. Lancashire
2,715,618 105
152
146
153
184
165
117
39
56
54
56
68
61
43
1,460,893 32
66
75
119
148
94
160
22
45
51
81
101
64
110
Q48. Merseyside
1,187,152
7
28
87
259
153
132
151
6
24
73
218 129 111 127
Q49. Cumbria,
Northumberland,
Tyne and Wear
Q50. North Yorkshire
and Humber
Q51. South Yorkshire
and Bassetlaw
Q52. West Yorkshire
1,926,791 39
63
126
230
220
245
253
20
33
65
119 114 127 131
1,658,665 62
69
69
138
84
87
108
37
42
42
83
51
52
65
1,456,464
8
27
32
32
46
35
40
5
19
22
22
32
24
27
2,275,387 81
66
40
80
82
130
146
36
29
18
35
36
57
64
18
AF Ablations
Q53. Arden,
Herefordshire and
Worcestershire
Q54. Birmingham
and The Black
Country
Q55. Derbyshire and
Nottinghamshire
Q56. East Anglia
AF Ablations per million population
1,612,080 58
67
102
111
174
256
226
36
42
63
69
108 159 140
2,419,500 77
51
66
88
187
271
278
32
21
27
36
77
112 115
1,963,967 53
77
82
98
92
92
106
27
39
42
50
47
47
2,424,901 11
124
395
279
285
316
316
5
51
163 115 118 130 130
Q57. Essex
1,724,950 186
147
256
228
244
233
153
108
85
148 132 141 135
Q58. Hertfordshire
and The South
Midlands
Q59. Leicestershire
and Lincolnshire
Q60. Shropshire and
Staffordshire
Q64. Bath,
Gloucestershire,
Swindon and
Wiltshire
Q65. Bristol, North
Somerset, Somerset
and South
Gloucestershire
Q66. Devon,
Cornwall and Isles Of
Scilly
Q67. Kent and
Medway
Q68. Surrey and
Sussex
Q69. Thames Valley
2,643,386 98
159
301
283
307
322
377
37
60
114 107 116 122 143
1,731,350 77
101
175
141
114
181
188
44
58
101
81
66
105 109
1,570,267 41
40
72
86
131
166
187
26
25
46
55
83
106 119
1,458,129 61
79
130
137
137
179
105
42
54
89
94
94
123
72
1,423,539 42
74
151
118
54
59
58
30
52
106
83
38
41
41
1,668,218 49
100
171
125
117
120
128
29
60
103
75
70
72
77
1,727,665 65
195
421
275
198
240
264
38
113 244 159 115 139 153
2,686,340 131
343
419
457
445
525
572
49
128 156 170 166 195 213
2,021,067 113
142
193
249
230
249
252
56
70
95
123 114 123 125
Q70. Wessex
2,684,407 72
124
157
249
266
334
418
27
46
58
93
Q71. London
8,173,941 392
555
961
894 1027 928
945
48
68
118 109 126 114 116
Scotland
5,254,800 155
171
45
69
39
81
83
29
33
9
13
7
15
16
South Wales
2,375,519 14
45
128
219
115
97
117
6
19
54
92
48
41
49
0
2
0
4
2
1
1
37
57
91
98
100 109 113
8
22
58
101
64
Wales
England (total)
Wales (total)
53,012,456 1,971 3,006 4,808 5,181 5,278 5,763 6,006
3,063,456
24
66
179
309
19
196
157
188
99
54
89
124 156
51
61
An increase in procedure rates in most areas is seen, such that provision is more uniform over the
Midlands, South-East and South, but remains low in areas such as Yorkshire, Wales, and the Bristol
area. Local rates vary from less than 30/million to over 200/million. This mirrors the total
ablations per million but not precisely, and the variation in total ablations is much less than that in
AF ablation.
The maps on the next 4 pages show annual AF ablation rates by region.
20
Fig 7: Regional rates of AF Ablation 2010
21
Fig 8: Regional rates of AF Ablation 2011
22
Fig 9: Regional rates of AF Ablation 2012
23
Fig 10: rates of AF Regional Ablation 2013
24
6.6 European Ablation Rate Comparisons
Variation within Europe
Comparative estimates of catheter ablation rates are available from the “White Book”, published
annually by the European Heart Rhythm Association. The information therein is the result of a
survey sent to national societies, and represents estimates, using methodologies (and presumably
completeness and accuracy) that vary widely from country to country. No data are available from
some major countries, e.g. Italy.
Estimated rates of overall ablation across Europe and ablation for atrial fibrillation for 2013 are
given in figures 11 & 12 respectively.
Fig 11: Overall Ablation in Europe2013
All Ablations 2013
651
Denmark
580
Belgium
566
Switzerland
506
Norway
482
Czech Republic
470
France
465
Sweden
418
Finland
412
Germany
338
Hungary
301
Estonia
295
Austria
291
UK
254
Iceland
253
250
Lithuania
239
Latvia
238
Europeanaverage=- 309
Spain
Luxembourg
229
Poland
209
Ireland
195
Slovakia
191
Portugal
182
Croatia
149
Russia
Slovenia
140
Serbia
140
134
Greece
83
Kazakhstan
77
Belarus
69
Montenegro
60
Ukraine
54
Georgia
54
Bulgaria
46
Armenia
39
Cyprus
38
Macedonia
29
Malta
24
Azerbaijan
0
50
100
150
200
250
300
350
400
450
per million population
25
500
550
600
650
700
Fig 12: AF Ablation in Europe 2013
AF Ablations 2013
Denmark
289
Norway
241
Belgium
225
196
Czech Republic
Switzerland
184
Sweden
179
Germany
144
129
France
124
Finland
UK
100
Ireland
94
Austria
94
86
Hungary
Slovenia
83
Iceland
73
Luxembourg
60
51
Spain
46
Poland
44
Russia
41
Greece
40
Croatia
38
Latvia
29
Slovakia
27
Serbia
17
Ukraine
15
Kazakhstan
15
Lithuania
9
Belarus
7
Georgia
7
Bulgaria
7
Cyprus
5
Armenia
3
Malta
2
Azerbaijan
European average =- 99
56
Estonia
Portugal
0
0
50
100
150
200
250
300
350
per million population
Rates in the UK are close to the overall “greater” European average, but are at the bottom of the
major Western European economies, and have been overtaken by some newer members of the
EU, such as Czech republic and Estonia. In Denmark, Belgium, and Switzerland, more than twice as
many ablations are performed per head of population.
26
6.7 Number and Type of Atrial Fibrillation Ablation Procedures
Atrial fibrillation is a complex procedure and now the commonest substrate for catheter ablation
and continues to grow.
The number of procedures between 2007 and 2014 are shown in Fig. 13. The current dataset was
not designed to precisely determine whether the atrial fibrillation was paroxysmal, persistent or
long standing persistent.
The “ECG” field permitted “paroxysmal”, “persistent”, or “unknown” to be recorded and we
believe that this was generally completed with regard to the rhythm on the day of the procedure.
This will exclude some of the patients who are defined by the international definition as
persistent; i.e. patients who have had any cardioversion or more than 7 days of AF. In the period
the proportion defined as persistent remains constant at 29-33% with no trend seen of increasing
ablation of more persistent AF.
Figure 13: AF ablations by type of AF and Year
7,000
Type unknown
6,000
5,000
1078
4,000
3,000
2,000
876
544
Paroxysmal
1144
Persistent
1044
1250
2494
2496
2786
1571
1680
1705
1678
2009
2010
2011
2012
2182
1602
1,000
1122
0
395
579
2007
2008
1238
2643
2217
2013-14
It is not possible at this time to ascertain why there is such a wide variation in access to AF
ablation. An obvious possible explanation is that some areas are geographically distant from
ablation centres. In these areas one would expect a low rate of all ablations and AF ablations. Two
other possible explanations are explored.
(1) There are centres which are doing more, or fewer, AF ablations than average in relation to
referral base because of personal bias on the part of referrers or indeed specialists
themselves. For example, a proportion of electrophysiologists regard AF ablation as a firstline therapy for some patients, whereas most will seek a trial of at least one antiarrhythmic
drug before offering ablation. One way of measuring this would be to measure the total
number of AF ablation (excluding AV node ablation) divided by the AVNRT ablations. This
27
is based on the assumption that AVNRT referrals are relatively constant and are related to
the population served. This may be affected by an established area having already treated
the prevalence of AVNRT, while a new centre is still finding a significant number of
untreated cases of this “traditional” arrhythmia.
(2) Patients with both AF and atrial flutter are treated with AF ablation in some areas, and
flutter ablation in others.
In order to explore these two possibilities, Table 4 shows the ratios of ablations of AF: AVNRT and
AF: Flutter. These are included in the two “funnel plots”, figures 14 and 15.
Table 4: Ratios of ablations of AF: AVNRT and AF: Flutter
Code
BAL
BAS
BHL
BOU
BRI
CHH
CHN
DGE
ERI
FRE
GEO
GJH
GRL
HAM
HH
KCH
LGI
MRI
NCR
NGS
NHB
PAP
PLY
QEB
RAD
RSC
SCM
SGH
Centre
Barts and the London
Basildon Hospital
Liverpool Heart & Chest Hospital
Royal Bournemouth Hospital
Bristol Royal Infirmary
Castle Hill Hospital
Nottingham City Hospital
Eastbourne District General Hospital
Edinburgh Royal Infirmary
Freeman Hospital Newcastle
St Georges Hospital
Golden Jubilee Hospital
Glenfield Hospital
Hammersmith Hospital
Harefield Hospital
Kings College Hospital
Leeds General Infirmary
Manchester Royal Infirmary
New Cross Hospital
(Wolverhampton Heart Centre)
Northern General Hospital Sheffield
Royal Brompton Hospital
Papworth Hospital
Derriford Hospital
Queen Elizabeth Hospital Birmingham
John Radcliffe Hospital
Royal Sussex County Hospital
The James Cook University Hospital
Southampton General Hospital
Total
AF
562
228
1081
518
211
190
218
443
361
755
188
390
712
354
406
279
657
146
247
376
73
415
226
54
30
56
192
68
315
154
122
268
158
208
52
179
61
68
51
42
189
70
47
52
54
55
104
120
7
91
119
47
77
56
148
19
56
65
59
230
173
29
22
33
107
70
172
26
88
166
72
49
83
139
44
66
218
902
948
167
751
447
359
357
297
35
346
294
58
342
182
182
106
72
41
110
159
22
122
70
43
69
54
33
168
157
37
212
91
85
69
72
28
AVNRT Flutter
Ratio Ratio
AF:
AF:
AVNRT Flutter
7.37
5.78
1.74
1.24
2.2
1.8
3.23
1.31
1.15
1.86
0.58
1.36
1.04
1.7
3.49
1.79
0.65
0.97
2.63
1.83
22
5.92
1.34
1.39
2.25
1.61
3.36
2.19
2.7
4.24
0.93
0.63
1.21
1.29
3.21
1.39
1.21
1.03
0.85
3.15
1.85
2.64
2.8
2.6
4.23
1.54
1.33
1.06
2.06
1.87
1.57
1.61
2
2.14
1.54
1
Code
STH
STO
UCL
UHW
VIC
WAL
WYT
Centre
St Thomas Hospital
University Hospital of North Staffs
University College Hospital
University Hospital of Wales
Blackpool Victoria Hospital
University Hospital Coventry
Wythenshawe Hospital
Total
AF
506
176
598
224
332
417
667
213
38
276
40
133
95
110
29
AVNRT Flutter
64
29
49
54
58
121
101
98
57
156
77
55
105
133
Ratio Ratio
AF:
AF:
AVNRT Flutter
3.33
2.17
1.31
0.67
5.63
1.77
0.74
0.52
2.29
2.42
0.79
0.9
1.09
0.83
Fig 14: Ratio of AF: AVNRT ablations 2013-14
Total procedures
0
200
400
600
800
1000
1200
Ratio of AF to AVNRT cases
100
10
1
0.1
Note: Ratio (Y-axis) is shown on a logarithmic scale. The national average value is 2.18
Fig 15: Ratio of AF: Flutter ablations 2013-14
Total procedures
0
200
400
600
800
1000
1200
Ratio of AF to AVNRT cases
10
1
0.1
Note: Ratio (Y-axis) is shown on a logarithmic scale. The national average value is 1.70
These graphs show that there is less variation in the ratio of AF: AVNRT and AF: flutter cases in the
six largest centres, which are all close to the national average; while in the medium-size and
smaller centres there is much more variation in the proportion of AF ablated compared to other
substrates.
30
6.8 Number of ablation substrates (‘targets’) per ablation procedure
The variation in the number of substrates per ablation procedure is represented in Table 5 by a
ratio of substrates treated per procedure per centre. This is broken down further in table 6 for the
number of substrates per procedure in detail.
The true number of substrates targeted may vary less, but some centres may only be reporting the
perceived “principal” substrate. This might be very common where both AF and atrial flutter are
targeted. Clearly where no substrate is reported this may be due to data quality.
Table 5: Ablation substrates (targets) per procedure
Code
Centre
Total
All reported
reported ablation targets
procedures
Targets
(‘substrates’)
per procedure
AHM BMI The Alexandra Hospital
148
158
1.07
BAS
Basildon Hospital
228
228
1.00
BCH
Birmingham Children’s Hospital
15
15
1.00
BHL
Liverpool Heart & Chest Hospital
1081
1315
1.22
BHR Royal Berkshire Hospital
54
55
1.02
BOU Royal Bournemouth Hospital
518
BRC
579
1.12
61
67
1.10
BRI
Bristol Royal Hospital for
Children
Bristol Royal Infirmary
211
215
1.02
CBS
Spire Southampton Hospital
86
98
1.14
CHN Nottingham City Hospital
218
218
1.00
CRO Cromwell Hospital
39
50
1.28
DGE Eastbourne District General
Hospital
ERI Edinburgh Royal Infirmary
443
563
1.27
361
361
1.00
FRE
755
899
1.19
FRM Frimley Park Hospital
39
39
1.00
GEO St Georges Hospital
188
208
1.11
GHB Spire Bristol Hospital
72
83
1.15
GJH
Golden Jubilee Hospital
390
408
1.05
GOS Great Ormond Street Hospital
49
49
1.00
GRL
Freeman Hospital Newcastle
Glenfield Hospital
712
840
1.18
HAM Hammersmith Hospital
354
358
1.01
HH
Harefield Hospital
406
432
1.06
HSC
Harley Street Clinic
423
439
1.04
KCH
Kings College Hospital
279
295
1.06
LBH
London Bridge Hospital
264
267
1.01
LEB
Spire Leeds Hospital
52
57
1.10
LGI
Leeds General Infirmary
657
711
1.08
MAI
Maidstone Hospital
53
53
1.00
MOR Morriston Hospital
99
100
1.01
MRI
146
175
1.20
247
266
1.08
Manchester Royal Infirmary
NCR New Cross Hospital
31
Code
Centre
Total
All reported
reported ablation targets
procedures
Targets
(‘substrates’)
per procedure
(Wolverhampton Heart Centre)
NGS Northern General Hospital
Sheffield
NHB Royal Brompton Hospital
218
225
1.03
902
999
1.11
NOR Norfolk & Norwich University
Hospital
PAP Papworth Hospital
144
145
1.01
948
992
1.05
PHB
122
149
1.22
167
185
1.11
QAP Queen Alexandra Hospital
66
67
1.02
QEB Queen Elizabeth Hospital
Birmingham
RAD John Radcliffe Hospital
751
873
1.16
447
553
1.24
RCH
Royal Cornwall Hospital
50
50
1.00
RDE
Royal Devon & Exeter Hospital
111
111
1.00
RSC
Royal Sussex County Hospital
359
371
1.03
RSU
Royal Surrey County Hospital
16
16
1.00
PLY
BMI The Priory Hospital
Birmingham
Derriford Hospital
SCM The James Cook University
Hospital
SGH Southampton General Hospital
357
375
1.05
297
315
1.06
STH
506
550
1.09
STM St Marys Hospital Paddington
St Thomas Hospital
51
51
1.00
STO
University Hospital of North
Staffs
University College Hospital
176
190
1.08
598
636
1.06
UHW University Hospital of Wales
224
250
1.12
VIC
332
340
1.02
WAL University Hospital Coventry
417
460
1.10
WAT Watford General Hospital
49
49
1.00
ACH Alder Hey Hospital*
26
2
0.08
BAL
562
551
0.98
CHH Castle Hill Hospital*
190
187
0.98
HHW Wellington Hospital North*
249
243
0.98
WYT Wythenshawe Hospital*
667
591
0.89
UCL
Blackpool Victoria Hospital
Barts and the London*
* These centres have reported less than one target per procedure and are advised to check their
data.
32
Table 6: Number of reported substrates (targets) per procedure
Code
Centre
0
1
ACH Alder Hey Hospital
24
2
AHM BMI The Alexandra Hospital
6
128
BAL
Barts and the London
11
551
0.0%
BAS
Basildon Hospital
228
0.0%
BCH Birmingham Children’s Hospital
15
0.0%
BHL
Liverpool Heart & Chest Hospital
2
3
4
5
% of cases with
>1 target
0.0%
12
902
139
BHR Royal Berkshire Hospital
53
1
BMI BMI The Meriden Hospital
1
2
25
9.9%
15
16.6%
1.9%
0.0%
BOU Royal Bournemouth Hospital
463
49
BRC
Bristol Royal Hospital for Children
55
6
9.8%
BRI
Bristol Royal Infirmary
191
12
5.9%
CBS
Spire Southampton Hospital
75
10
183
2
CHH Castle Hill Hospital
8
5
6
1
218
CRO Cromwell Hospital
29
9
1
DGE Eastbourne District General Hospital
348
75
16
ERI
Edinburgh Royal Infirmary
361
FRE
Freeman Hospital Newcastle
625
0.0%
113
39
GEO St Georges Hospital
168
20
2
59
10
GJH
2
368
20
GRL
Glenfield Hospital
Harefield Hospital
12
3
1
1
21.4%
17.0%
10.6%
1
15.7%
5.2%
49
HAM Hammersmith Hospital
HH
3
0.0%
GHB Spire Bristol Hospital
GOS Great Ormond Street Hospital
25.6%
0.0%
FRM Frimley Park Hospital
Golden Jubilee Hospital
12.8%
1.1%
CHN Nottingham City Hospital
2
10.6%
0.0%
601
93
350
4
15
2
15.5%
1.1%
1
383
18
HHW Wellington Hospital North
13
229
7
HSC
3
403
15
2
4.0%
KCH Kings College Hospital
264
14
1
5.4%
LBH
London Bridge Hospital
261
3
1.1%
LEB
Spire Leeds Hospital
1
45
6
11.8%
LGI
Leeds General Infirmary
1
605
47
Harley Street Clinic
MAI Maidstone Hospital
53
MOR Morriston Hospital
98
1
MRI Manchester Royal Infirmary
122
19
3
1
5.4%
3.0%
4
7.8%
0.0%
1.0%
5
16.4%
NCR New Cross Hospital (Wolverhampton
Heart Centre)
NGS Northern General Hospital Sheffield
1
226
20
8.1%
1
209
8
3.7%
NHB Royal Brompton Hospital
3
806
86
143
1
7
NOR Norfolk & Norwich University
Hospital
PAP Papworth Hospital
908
36
4
PHB BMI The Priory Hospital Birmingham
99
20
2
33
10.3%
0.7%
4.2%
1
18.9%
Code
1
2
149
18
10.8%
QAP Queen Alexandra Hospital
65
1
1.5%
QEB Queen Elizabeth Hospital
Birmingham
RAD John Radcliffe Hospital
644
95
9
3
14.2%
342
93
7
1
22.8%
PLY
Centre
0
Derriford Hospital
4
3
4
5
% of cases with
>1 target
RCH Royal Cornwall Hospital
50
0.0%
RDE Royal Devon & Exeter Hospital
111
0.0%
RSC
Royal Sussex County Hospital
347
RSU Royal Surrey County Hospital
16
SCM The James Cook University Hospital
339
18
5.0%
SGH Southampton General Hospital
279
18
6.1%
461
43
STH
St Thomas Hospital
1
STM St Marys Hospital Paddington
12
3.3%
0.0%
1
8.7%
51
0.0%
STO
University Hospital of North Staffs
1
164
8
2
UCL
University College Hospital
24
518
50
6
9.8%
200
22
2
10.7%
4
317
10
1
3.4%
3
374
34
6
9.7%
UHW University Hospital of Wales
VIC
Blackpool Victoria Hospital
WAL University Hospital Coventry
WAT Watford General Hospital
WYT Wythenshawe Hospital
49
87
570
1
6.3%
0.0%
9
1
1.7%
Note: The minimum should be one.
Table 7 shows there has been no increase in the relative amount of ablation for chronic atrial
fibrillation and much of this expansion should be in paroxysmal atrial fibrillation ablation. There is
certainly evidence that some areas have very low levels of AF ablation, which suggests many
patients who would benefit are not receiving this treatment.
34
6.9: Data quality for key fields
Table 8 provides details of the data quality of all key fields. It should be noted that data “quality” in this section refers to the proportion of key fields that
have been completed, irrespective of data correctness. This may lead to misinterpretation. For example, software in many centres returns “0” for
complications as a default; it follows that a centre that neglects to enter its complications may appear to have 100% data quality and no complications.
Legend:
Code
greater than 90% complete
Centre
Procedures
80-90% complete
<80% complete
Overall Data Hospital NHS DOB Sex Postcode First Arrhythmia Indication Proc
First Procedure Ablation Success Complics Early
Quality Index
Paced
Date Op Name Type Attempted
Recur
ACH
Alder Hey Hospital
26
82%
100%
100% 100% 100%
100%
92%
100%
15%
100%
100%
8%
100%
92%
15%
100%
AHM
BMI The Alexandra Hospital
148
90%
100%
0%
100% 100%
89%
97%
96%
99%
100%
100%
93%
89%
97%
87%
97%
BAL
Barts and the London
562
92%
100%
93%
100% 100%
37%
86%
99%
91%
100%
76%
95%
100%
100%
99%
100%
BAS
Basildon Hospital
228
95%
100%
99%
100% 100%
94%
100%
100%
96%
100%
100%
100%
100%
92%
42%
100%
BCH
Birmingham Childrens Hospital
15
94%
100%
53%
100% 100%
60%
100%
100%
100%
100%
100%
100%
100%
100%
100%
93%
BHL
Liverpool Heart & Chest Hospital
1081
98%
100%
98%
100% 100%
90%
100%
100%
99%
100%
99%
99%
87%
100%
93%
100%
BHR
Royal Berkshire Hospital
54
95%
100%
100% 100% 100%
52%
100%
100%
100%
100%
100%
100%
100%
94%
100%
80%
BMI
BMI The Meriden Hospital
1
93%
100%
100% 100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
BOU
Royal Bournemouth Hospital
518
99%
100%
100% 100% 100%
92%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
BRC
Bristol Royal Hospital for Children
61
90%
100%
0%
100% 100%
84%
97%
98%
98%
100%
98%
97%
98%
95%
98%
93%
BRI
Bristol Royal Infirmary
211
85%
100%
99%
100% 100%
100%
98%
75%
73%
100%
100%
95%
73%
82%
56%
22%
CBS
Spire Southampton Hospital
86
86%
100%
0%
100% 100%
95%
95%
95%
99%
100%
99%
100%
100%
100%
100%
1%
CHH
Castle Hill Hospital
190
98%
100%
100% 100% 100%
100%
100%
100%
100%
100%
100%
96%
99%
99%
82%
96%
CHN
Nottingham City Hospital
218
98%
100%
100% 100% 100%
86%
100%
100%
98%
100%
100%
100%
100%
98%
94%
100%
CRO
Cromwell Hospital
39
88%
100%
100% 100%
92%
100%
100%
97%
100%
100%
100%
100%
97%
100%
26%
DGE
Eastbourne District General Hospital
443
93%
100%
100% 100% 100%
1%
100%
100%
97%
100%
99%
100%
98%
100%
99%
100%
ERI
Edinburgh Royal Infirmary
361
93%
100%
100% 100% 100%
29%
100%
100%
89%
100%
100%
100%
100%
94%
89%
100%
FRE
Freeman Hospital Newcastle
755
97%
100%
99%
100% 100%
99%
99%
94%
95%
100%
89%
98%
100%
97%
93%
92%
FRM
Frimley Park Hospital
39
97%
100%
100% 100% 100%
74%
97%
97%
100%
100%
100%
97%
100%
100%
97%
97%
0%
0%
35
Code
Centre
Procedures
Overall Data Hospital NHS DOB Sex Postcode First Arrhythmia Indication Proc
First Procedure Ablation Success Complics Early
Quality Index
Paced
Date Op Name Type Attempted
Recur
GEO
St Georges Hospital
188
70%
100%
66%
100% 100%
1%
0%
0%
81%
100%
100%
100%
99%
97%
98%
0%
GHB
Spire Bristol Hospital
72
91%
100%
21%
100% 100%
83%
94%
96%
94%
100%
99%
97%
99%
99%
96%
88%
GJH
Golden Jubilee Hospital
390
98%
100%
100% 100% 100%
100%
100%
91%
99%
100%
100%
99%
99%
96%
99%
85%
GOS
Great Ormond Street Hospital
49
81%
100%
10%
96%
10%
43%
98%
100%
100%
100%
100%
100%
100%
100%
59%
GRL
Glenfield Hospital
712
100%
100%
100% 100% 100%
100%
100%
100%
100%
100%
100%
100%
100%
98%
99%
100%
HAM
Hammersmith Hospital
354
40%
100%
95%
98%
0%
0%
0%
0%
100%
100%
100%
0%
0%
1%
0%
HH
Harefield Hospital
406
89%
100%
94%
100% 100%
100%
97%
99%
99%
100%
99%
99%
100%
48%
100%
0%
HHW
Wellington Hospital North
249
89%
100%
1%
100% 100%
100%
100%
100%
100%
100%
100%
31%
100%
100%
100%
100%
HSC
Harley Street Clinic
423
92%
100%
0%
100% 100%
100%
100%
100%
100%
100%
100%
83%
100%
100%
100%
100%
KCH
Kings College Hospital
279
95%
100%
100% 100% 100%
100%
99%
100%
100%
100%
22%
100%
100%
100%
100%
99%
LBH
London Bridge Hospital
264
94%
100%
10%
100% 100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
LEB
Spire Leeds Hospital
52
85%
100%
0%
100% 87%
44%
85%
85%
100%
100%
98%
98%
100%
96%
94%
90%
LGI
Leeds General Infirmary
657
96%
100%
100% 100% 100%
100%
89%
93%
72%
100%
100%
100%
98%
97%
99%
99%
MAI
Maidstone Hospital
53
91%
100%
100% 100% 100%
6%
100%
100%
100%
100%
100%
100%
100%
57%
98%
100%
MOR
Morriston Hospital
99
90%
100%
52%
100% 97%
53%
98%
98%
100%
100%
100%
100%
99%
99%
99%
49%
MRI
Manchester Royal Infirmary
146
82%
100%
95%
100% 100%
100%
78%
76%
74%
100%
79%
99%
79%
73%
77%
0%
NCR
New Cross Hospital (Wolverhampton
Heart Centre)
247
100%
100%
100% 100% 100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
NGS
Northern General Hospital Sheffield
218
91%
100%
100% 100% 100%
79%
100%
99%
100%
100%
100%
99%
100%
97%
98%
0%
NHB
Royal Brompton Hospital
902
87%
100%
88%
100% 100%
86%
98%
99%
99%
100%
99%
99%
100%
38%
96%
0%
NOR
Norfolk & Norwich University Hospital
144
100%
100%
99%
100% 100%
99%
100%
100%
99%
100%
100%
100%
100%
99%
99%
97%
PAP
Papworth Hospital
948
96%
100%
100% 100% 100%
100%
100%
100%
100%
100%
100%
100%
91%
100%
55%
100%
PHB
BMI The Priory Hospital Birmingham
122
85%
100%
100% 100%
80%
99%
99%
98%
100%
100%
99%
99%
99%
99%
0%
PLY
Derriford Hospital
167
100%
100%
100% 100% 100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
QAP
Queen Alexandra Hospital
66
99%
100%
100% 100% 100%
97%
98%
98%
98%
100%
98%
100%
98%
100%
98%
98%
QEB
Queen Elizabeth Hospital Birmingham
751
87%
100%
18%
100% 99%
91%
99%
100%
100%
100%
100%
100%
100%
100%
100%
0%
RAD
John Radcliffe Hospital
447
99%
100%
94%
100% 100%
95%
100%
100%
100%
100%
99%
94%
100%
100%
100%
100%
RCH
Royal Cornwall Hospital
50
93%
100%
98%
100% 100%
98%
100%
100%
100%
100%
100%
100%
100%
98%
0%
100%
RDE
Royal Devon & Exeter Hospital
111
100%
100%
100% 100% 100%
96%
100%
100%
100%
100%
100%
100%
100%
100%
99%
100%
1%
98%
2%
36
Code
Centre
Procedures
Overall Data Hospital NHS DOB Sex Postcode First Arrhythmia Indication Proc
First Procedure Ablation Success Complics Early
Quality Index
Paced
Date Op Name Type Attempted
Recur
RSC
Royal Sussex County Hospital
359
99%
100%
99%
100% 100%
99%
99%
95%
94%
100%
100%
100%
100%
100%
100%
100%
RSU
Royal Surrey County Hospital
16
83%
100%
94%
100% 100%
81%
0%
0%
100%
100%
94%
100%
100%
100%
100%
69%
SCM
The James Cook University Hospital
357
92%
100%
100% 100% 98%
92%
95%
100%
99%
100%
100%
100%
99%
98%
99%
0%
SGH
Southampton General Hospital
297
86%
100%
49%
100% 97%
59%
97%
98%
98%
100%
100%
100%
100%
99%
99%
0%
STH
St Thomas Hospital
506
93%
100%
98%
100% 100%
3%
100%
98%
98%
100%
98%
98%
99%
100%
98%
100%
STM
St Marys Hospital Paddington
51
40%
100%
96%
98%
0%
0%
0%
0%
100%
100%
100%
0%
0%
0%
0%
STO
University Hospital of North Staffs
176
88%
100%
54%
100% 100%
97%
86%
93%
97%
100%
100%
98%
100%
95%
97%
0%
UCL
University College Hospital
598
92%
100%
96%
100% 100%
71%
93%
97%
87%
100%
95%
86%
78%
97%
76%
98%
UHW
University Hospital of Wales
224
96%
100%
52%
100% 100%
96%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
VIC
Blackpool Victoria Hospital
332
78%
100%
91%
100% 100%
96%
73%
75%
75%
100%
100%
96%
65%
63%
40%
1%
WAL
University Hospital Coventry
417
100%
100%
100% 100% 100%
100%
100%
100%
100%
100%
100%
99%
100%
100%
100%
100%
WAT
Watford General Hospital
49
93%
100%
98%
0%
100%
100%
92%
100%
100%
100%
100%
100%
100%
98%
WYT
Wythenshawe Hospital
667
88%
100%
100% 100% 100%
100%
96%
97%
69%
100%
99%
68%
99%
92%
2%
100%
0%
100% 100%
37
7. Conclusions
Ablation growth has slowed but continues to increase. The major growth seen is in atrial fibrillation
ablation, but with no evidence that there is a greater emphasis on more persistent/ chronic atrial
fibrillation patients. There is widespread variation in ablation rates per capita, and this appears to be a
function of total local ablation numbers. However the bigger centres appear to do more atrial fibrillation
ablation in proportion to flutter and AVNRT ablation. The overall rates for ablation are very close to
average for “greater” Europe but are at the lower end of the scale for the older EU members in Northern
Europe.
38
8. Individual Hospital Activity
39
Hospital Reports
All ablation procedures registered in NICOR at 1/11/2014. Q45. Durham, Darlington and Tees
The James Cook University Hospital
Centre: Town/City: Middlesborough
Local Area Team: Q45. Durham, Darlington and Tees
Procedures registered with NICOR for 2013‐14 Total
357
Ablation Procedures
Ablation Targets reported
Atrial fibrillation
Atrial flutter
AVNRT
Atrial ectopy/tachycardia
Ventricular ectopy/tachycardia
Complete AV nodal block
Accessory pathway
Other
375
106
69
69
7
22
63
31
1
40
Q46. Greater Manchester
BMI The Alexandra Hospital
Centre: Town/City: Manchester
Local Area Team: Q46. Greater Manchester
Procedures registered with NICOR for 2013‐14 Total
148
Ablation Procedures
Ablation Targets reported
Atrial fibrillation
Atrial flutter
AVNRT
Atrial ectopy/tachycardia
Ventricular ectopy/tachycardia
Complete AV nodal block
Accessory pathway
Other
158
75
30
13
4
2
7
14
6
Manchester Royal Infirmary
Centre: Town/City: Manchester
Local Area Team: Q46. Greater Manchester
Procedures registered with NICOR for 2013‐14 Total
146
Ablation Procedures
Ablation Targets reported
Atrial fibrillation
Atrial flutter
AVNRT
Atrial ectopy/tachycardia
Ventricular ectopy/tachycardia
Complete AV nodal block
Accessory pathway
Other
175
61
44
19
10
7
9
14
0
Wythenshawe Hospital
Centre: Town/City: Manchester
Local Area Team: Q46. Greater Manchester
Procedures registered with NICOR for 2013‐14 Total
667
Ablation Procedures
Ablation Targets reported
Atrial fibrillation
Atrial flutter
AVNRT
Atrial ectopy/tachycardia
Ventricular ectopy/tachycardia
Complete AV nodal block
Accessory pathway
Other
591
110
133
101
3
50
126
63
0
41
Q47. Lancashire
Blackpool Victoria Hospital
Centre: Town/City: Blackpool
Local Area Team: Q47. Lancashire
Procedures registered with NICOR for 2013‐14 Total
332
Ablation Procedures
Ablation Targets reported
Atrial fibrillation
Atrial flutter
AVNRT
Atrial ectopy/tachycardia
Ventricular ectopy/tachycardia
Complete AV nodal block
Accessory pathway
Other
340
133
55
58
8
10
44
23
2
Q48. Merseyside
Alder Hey Hospital
Centre: Town/City: Liverpool
Local Area Team: Q48. Merseyside
Procedures registered with NICOR for 2013‐14 Total
26
Ablation Procedures
Ablation Targets reported
Atrial fibrillation
Atrial flutter
AVNRT
Atrial ectopy/tachycardia
Ventricular ectopy/tachycardia
Complete AV nodal block
Accessory pathway
Other
2
0
0
0
0
0
0
0
2
Liverpool Heart & Chest Hospital
Centre: Town/City: Liverpool
Local Area Team: Q48. Merseyside
Procedures registered with NICOR for 2013‐14 Total
1081
Ablation Procedures
Ablation Targets reported
Atrial fibrillation
Atrial flutter
AVNRT
Atrial ectopy/tachycardia
Ventricular ectopy/tachycardia
Complete AV nodal block
Accessory pathway
Other
1315
415
230
189
48
76
94
76
70
42
Q49. Cumbria, Northumberland, Tyne and Wear
Freeman Hospital Newcastle
Centre: Town/City: Newcastle
Local Area Team: Q49. Cumbria, Northumberland, Tyne and We
Procedures registered with NICOR for 2013‐14 Total
755
Ablation Procedures
Ablation Targets reported
Atrial fibrillation
Atrial flutter
AVNRT
Atrial ectopy/tachycardia
Ventricular ectopy/tachycardia
Complete AV nodal block
Accessory pathway
Other
899
315
172
120
32
66
51
63
28
Q50. North Yorkshire and Humber
Castle Hill Hospital
Centre: Town/City: Hull
Local Area Team: Q50. North Yorkshire and Humber
Procedures registered with NICOR for 2013‐14 Total
190
Ablation Procedures
Ablation Targets reported
Atrial fibrillation
Atrial flutter
AVNRT
Atrial ectopy/tachycardia
Ventricular ectopy/tachycardia
Complete AV nodal block
Accessory pathway
Other
187
30
22
52
5
16
12
14
35
43
Q51. South Yorkshire and Bassetlaw
Northern General Hospital Sheffield
Centre: Town/City: Sheffield
Local Area Team: Q51. South Yorkshire and Bassetlaw
Procedures registered with NICOR for 2013‐14 Total
218
Ablation Procedures
Ablation Targets reported
Atrial fibrillation
Atrial flutter
AVNRT
Atrial ectopy/tachycardia
Ventricular ectopy/tachycardia
Complete AV nodal block
Accessory pathway
Other
225
35
33
41
9
23
28
27
27
Q52. West Yorkshire
Leeds General Infirmary
Centre: Town/City: Leeds
Local Area Team: Q52. West Yorkshire
Procedures registered with NICOR for 2013‐14 Total
657
Ablation Procedures
Ablation Targets reported
Atrial fibrillation
Atrial flutter
AVNRT
Atrial ectopy/tachycardia
Ventricular ectopy/tachycardia
Complete AV nodal block
Accessory pathway
Other
711
179
139
148
21
57
34
105
8
Spire Leeds Hospital
Centre: Town/City: Leeds
Local Area Team: Q52. West Yorkshire
Procedures registered with NICOR for 2013‐14 Total
52
Ablation Procedures
Ablation Targets reported
Atrial fibrillation
Atrial flutter
AVNRT
Atrial ectopy/tachycardia
Ventricular ectopy/tachycardia
Complete AV nodal block
Accessory pathway
Other
57
17
9
15
4
1
0
5
2
44
Q53. Arden, Herefordshire and Worcestershire
BMI The Meriden Hospital
Centre: Town/City: Coventry
Local Area Team: Q53. Arden, Herefordshire and Worcestershir
Procedures registered with NICOR for 2013‐14 Total
1
Ablation Procedures
Ablation Targets reported
Atrial fibrillation
Atrial flutter
AVNRT
Atrial ectopy/tachycardia
Ventricular ectopy/tachycardia
Complete AV nodal block
Accessory pathway
Other
1
0
1
0
0
0
0
0
0
University Hospital Coventry
Centre: Town/City: Coventry
Local Area Team: Q53. Arden, Herefordshire and Worcestershir
Procedures registered with NICOR for 2013‐14 Total
417
Ablation Procedures
Ablation Targets reported
Atrial fibrillation
Atrial flutter
AVNRT
Atrial ectopy/tachycardia
Ventricular ectopy/tachycardia
Complete AV nodal block
Accessory pathway
Other
460
95
105
121
13
2
19
73
3
45
Q54. Birmingham and The Black Country
Birmingham Childrens Hospital
Centre: Town/City: Birmingham
Local Area Team: Q54. Birmingham and The Black Country
Procedures registered with NICOR for 2013‐14 Total
15
Ablation Procedures
Ablation Targets reported
Atrial fibrillation
Atrial flutter
AVNRT
Atrial ectopy/tachycardia
Ventricular ectopy/tachycardia
Complete AV nodal block
Accessory pathway
Other
15
0
1
4
2
2
0
6
0
BMI The Priory Hospital Birmingham
Centre: Town/City: Edgbaston
Local Area Team: Q54. Birmingham and The Black Country
Procedures registered with NICOR for 2013‐14 Total
122
Ablation Procedures
Ablation Targets reported
Atrial fibrillation
Atrial flutter
AVNRT
Atrial ectopy/tachycardia
Ventricular ectopy/tachycardia
Complete AV nodal block
Accessory pathway
Other
149
86
35
5
8
3
1
3
0
New Cross Hospital (Wolverhampton Heart Centre)
Centre: Town/City: Wolverhampton
Local Area Team: Q54. Birmingham and The Black Country
Procedures registered with NICOR for 2013‐14 Total
247
Ablation Procedures
Ablation Targets reported
Atrial fibrillation
Atrial flutter
AVNRT
Atrial ectopy/tachycardia
Ventricular ectopy/tachycardia
Complete AV nodal block
Accessory pathway
Other
266
68
66
56
11
19
15
27
1
46
Queen Elizabeth Hospital Birmingham
Centre: Town/City: Birmingham
Local Area Team: Q54. Birmingham and The Black Country
Procedures registered with NICOR for 2013‐14 Total
751
Ablation Procedures
Ablation Targets reported
Atrial fibrillation
Atrial flutter
AVNRT
Atrial ectopy/tachycardia
Ventricular ectopy/tachycardia
Complete AV nodal block
Accessory pathway
Other
873
342
212
122
29
54
14
61
3
Q55. Derbyshire and Nottinghamshire
Nottingham City Hospital
Centre: Town/City: Nottingham
Local Area Team: Q55. Derbyshire and Nottinghamshire
Procedures registered with NICOR for 2013‐14 Total
218
Ablation Procedures
Ablation Targets reported
Atrial fibrillation
Atrial flutter
AVNRT
Atrial ectopy/tachycardia
Ventricular ectopy/tachycardia
Complete AV nodal block
Accessory pathway
Other
218
56
33
54
8
4
20
41
2
47
Q56. East Anglia
Norfolk & Norwich University Hospital
Centre: Town/City: Norwich
Local Area Team: Q56. East Anglia
Procedures registered with NICOR for 2013‐14 Total
144
Ablation Procedures
Ablation Targets reported
Atrial fibrillation
Atrial flutter
AVNRT
Atrial ectopy/tachycardia
Ventricular ectopy/tachycardia
Complete AV nodal block
Accessory pathway
Other
145
0
50
38
6
7
18
26
0
Papworth Hospital
Centre: Town/City: Cambridge
Local Area Team: Q56. East Anglia
Procedures registered with NICOR for 2013‐14 Total
948
Ablation Procedures
Ablation Targets reported
Atrial fibrillation
Atrial flutter
AVNRT
Atrial ectopy/tachycardia
Ventricular ectopy/tachycardia
Complete AV nodal block
Accessory pathway
Other
992
294
157
159
47
58
74
64
135
Q57. Essex
Basildon Hospital
Centre: Town/City: Basildon
Local Area Team: Q57. Essex
Procedures registered with NICOR for 2013‐14 Total
228
Ablation Procedures
Ablation Targets reported
Atrial fibrillation
Atrial flutter
AVNRT
Atrial ectopy/tachycardia
Ventricular ectopy/tachycardia
Complete AV nodal block
Accessory pathway
Other
228
73
59
42
3
9
6
26
10
48
Q58. Hertfordshire and The South Midlands
Watford General Hospital
Centre: Town/City: Watford
Local Area Team: Q58. Hertfordshire and The South Midlands
Procedures registered with NICOR for 2013‐14 Total
49
Ablation Procedures
Ablation Targets reported
Atrial fibrillation
Atrial flutter
AVNRT
Atrial ectopy/tachycardia
Ventricular ectopy/tachycardia
Complete AV nodal block
Accessory pathway
Other
49
0
24
21
1
0
0
3
0
Q59. Leicestershire and Lincolnshire
Glenfield Hospital
Centre: Town/City: Leicester
Local Area Team: Q59. Leicestershire and Lincolnshire
Procedures registered with NICOR for 2013‐14 Total
712
Ablation Procedures
Ablation Targets reported
Atrial fibrillation
Atrial flutter
AVNRT
Atrial ectopy/tachycardia
Ventricular ectopy/tachycardia
Complete AV nodal block
Accessory pathway
Other
840
268
166
119
39
51
23
84
36
49
Q60. Shropshire and Staffordshire
University Hospital of North Staffs
Centre: Town/City: Stoke‐on‐Trent
Local Area Team: Q60. Shropshire and Staffordshire
Procedures registered with NICOR for 2013‐14 Total
176
Ablation Procedures
Ablation Targets reported
Atrial fibrillation
Atrial flutter
AVNRT
Atrial ectopy/tachycardia
Ventricular ectopy/tachycardia
Complete AV nodal block
Accessory pathway
Other
190
38
57
29
2
9
21
27
1
50
Q65. Bristol, North Somerset, Somerset and South Gloucestershire
Bristol Royal Hospital for Children
Centre: Town/City: Bristol
Local Area Team: Q65. Bristol, North Somerset, Somerset and S
Procedures registered with NICOR for 2013‐14 Total
61
Ablation Procedures
Ablation Targets reported
Atrial fibrillation
Atrial flutter
AVNRT
Atrial ectopy/tachycardia
Ventricular ectopy/tachycardia
Complete AV nodal block
Accessory pathway
Other
67
0
0
18
11
2
0
31
0
Bristol Royal Infirmary
Centre: Town/City: Bristol
Local Area Team: Q65. Bristol, North Somerset, Somerset and S
Procedures registered with NICOR for 2013‐14 Total
211
Ablation Procedures
Ablation Targets reported
Atrial fibrillation
Atrial flutter
AVNRT
Atrial ectopy/tachycardia
Ventricular ectopy/tachycardia
Complete AV nodal block
Accessory pathway
Other
215
54
29
47
4
13
34
27
1
Spire Bristol Hospital
Centre: Town/City: Bristol
Local Area Team: Q65. Bristol, North Somerset, Somerset and S
Procedures registered with NICOR for 2013‐14 Total
72
Ablation Procedures
Ablation Targets reported
Atrial fibrillation
Atrial flutter
AVNRT
Atrial ectopy/tachycardia
Ventricular ectopy/tachycardia
Complete AV nodal block
Accessory pathway
Other
83
35
23
8
6
4
2
1
3
51
Q66. Devon, Cornwall and Isles Of Scilly
Derriford Hospital
Centre: Town/City: Plymouth
Local Area Team: Q66. Devon, Cornwall and Isles Of Scilly
Procedures registered with NICOR for 2013‐14 Total
167
Ablation Procedures
Ablation Targets reported
Atrial fibrillation
Atrial flutter
AVNRT
Atrial ectopy/tachycardia
Ventricular ectopy/tachycardia
Complete AV nodal block
Accessory pathway
Other
185
58
37
22
4
14
15
14
19
Royal Cornwall Hospital
Centre: Town/City: Truro
Local Area Team: Q66. Devon, Cornwall and Isles Of Scilly
Procedures registered with NICOR for 2013‐14 Total
50
Ablation Procedures
Ablation Targets reported
Atrial fibrillation
Atrial flutter
AVNRT
Atrial ectopy/tachycardia
Ventricular ectopy/tachycardia
Complete AV nodal block
Accessory pathway
Other
50
0
14
11
1
1
12
10
1
Royal Devon & Exeter Hospital
Centre: Town/City: Exeter
Local Area Team: Q66. Devon, Cornwall and Isles Of Scilly
Procedures registered with NICOR for 2013‐14 Total
111
Ablation Procedures
Ablation Targets reported
Atrial fibrillation
Atrial flutter
AVNRT
Atrial ectopy/tachycardia
Ventricular ectopy/tachycardia
Complete AV nodal block
Accessory pathway
Other
111
0
67
24
0
0
9
11
0
52
Q67. Kent and Medway
Maidstone Hospital
Centre: Town/City: Maidstone
Local Area Team: Q67. Kent and Medway
Procedures registered with NICOR for 2013‐14 Total
53
Ablation Procedures
Ablation Targets reported
Atrial fibrillation
Atrial flutter
AVNRT
Atrial ectopy/tachycardia
Ventricular ectopy/tachycardia
Complete AV nodal block
Accessory pathway
Other
53
0
24
14
0
1
2
4
8
53
Q68. Surrey and Sussex
Eastbourne District General Hospital
Centre: Town/City: Eastbourne
Local Area Team: Q68. Surrey and Sussex
Procedures registered with NICOR for 2013‐14 Total
443
Ablation Procedures
Ablation Targets reported
Atrial fibrillation
Atrial flutter
AVNRT
Atrial ectopy/tachycardia
Ventricular ectopy/tachycardia
Complete AV nodal block
Accessory pathway
Other
563
192
107
55
34
33
52
17
27
Frimley Park Hospital
Centre: Town/City: Frimley
Local Area Team: Q68. Surrey and Sussex
Procedures registered with NICOR for 2013‐14 Total
39
Ablation Procedures
Ablation Targets reported
Atrial fibrillation
Atrial flutter
AVNRT
Atrial ectopy/tachycardia
Ventricular ectopy/tachycardia
Complete AV nodal block
Accessory pathway
Other
39
0
18
17
0
1
0
3
0
Royal Surrey County Hospital
Centre: Town/City: Guildford
Local Area Team: Q68. Surrey and Sussex
Procedures registered with NICOR for 2013‐14 Total
16
Ablation Procedures
Ablation Targets reported
Atrial fibrillation
Atrial flutter
AVNRT
Atrial ectopy/tachycardia
Ventricular ectopy/tachycardia
Complete AV nodal block
Accessory pathway
Other
16
0
13
1
0
0
2
0
0
54
Royal Sussex County Hospital
Centre: Town/City: Brighton
Local Area Team: Q68. Surrey and Sussex
Procedures registered with NICOR for 2013‐14 Total
359
Ablation Procedures
Ablation Targets reported
Atrial fibrillation
Atrial flutter
AVNRT
Atrial ectopy/tachycardia
Ventricular ectopy/tachycardia
Complete AV nodal block
Accessory pathway
Other
371
182
85
43
15
12
10
21
2
Q69. Thames Valley
John Radcliffe Hospital
Centre: Town/City: Oxford
Local Area Team: Q69. Thames Valley
Procedures registered with NICOR for 2013‐14 Total
447
Ablation Procedures
Ablation Targets reported
Atrial fibrillation
Atrial flutter
AVNRT
Atrial ectopy/tachycardia
Ventricular ectopy/tachycardia
Complete AV nodal block
Accessory pathway
Other
553
182
91
70
34
34
19
39
33
Royal Berkshire Hospital
Centre: Town/City: Reading
Local Area Team: Q69. Thames Valley
Procedures registered with NICOR for 2013‐14 Total
54
Ablation Procedures
Ablation Targets reported
Atrial fibrillation
Atrial flutter
AVNRT
Atrial ectopy/tachycardia
Ventricular ectopy/tachycardia
Complete AV nodal block
Accessory pathway
Other
55
0
24
12
4
0
11
4
0
55
Q70. Wessex
Queen Alexandra Hospital
Centre: Town/City: Portsmouth
Local Area Team: Q70. Wessex
Procedures registered with NICOR for 2013‐14 Total
66
Ablation Procedures
Ablation Targets reported
Atrial fibrillation
Atrial flutter
AVNRT
Atrial ectopy/tachycardia
Ventricular ectopy/tachycardia
Complete AV nodal block
Accessory pathway
Other
67
0
22
14
4
2
16
9
0
Royal Bournemouth Hospital
Centre: Town/City: Bournemouth
Local Area Team: Q70. Wessex
Procedures registered with NICOR for 2013‐14 Total
518
Ablation Procedures
Ablation Targets reported
Atrial fibrillation
Atrial flutter
AVNRT
Atrial ectopy/tachycardia
Ventricular ectopy/tachycardia
Complete AV nodal block
Accessory pathway
Other
579
226
173
70
21
18
28
39
0
Southampton General Hospital
Centre: Town/City: Southampton
Local Area Team: Q70. Wessex
Procedures registered with NICOR for 2013‐14 Total
297
Ablation Procedures
Ablation Targets reported
Atrial fibrillation
Atrial flutter
AVNRT
Atrial ectopy/tachycardia
Ventricular ectopy/tachycardia
Complete AV nodal block
Accessory pathway
Other
315
72
72
54
19
21
34
40
1
56
Spire Southampton Hospital
Centre: Town/City: Southampton
Local Area Team: Q70. Wessex
Procedures registered with NICOR for 2013‐14 Total
86
Ablation Procedures
Ablation Targets reported
Atrial fibrillation
Atrial flutter
AVNRT
Atrial ectopy/tachycardia
Ventricular ectopy/tachycardia
Complete AV nodal block
Accessory pathway
Other
98
30
29
11
4
0
6
8
1
57
Q71. London
Barts and the London
Centre: Town/City: London
Local Area Team: Q71. London
Procedures registered with NICOR for 2013‐14 Total
562
Ablation Procedures
Ablation Targets reported
Atrial fibrillation
Atrial flutter
AVNRT
Atrial ectopy/tachycardia
Ventricular ectopy/tachycardia
Complete AV nodal block
Accessory pathway
Other
551
376
65
51
4
16
19
16
4
Cromwell Hospital
Centre: Town/City: London
Local Area Team: Q71. London
Procedures registered with NICOR for 2013‐14 Total
39
Ablation Procedures
Ablation Targets reported
Atrial fibrillation
Atrial flutter
AVNRT
Atrial ectopy/tachycardia
Ventricular ectopy/tachycardia
Complete AV nodal block
Accessory pathway
Other
50
26
12
3
5
1
1
2
0
Great Ormond Street Hospital
Centre: Town/City: London
Local Area Team: Q71. London
Procedures registered with NICOR for 2013‐14 Total
49
Ablation Procedures
Ablation Targets reported
Atrial fibrillation
Atrial flutter
AVNRT
Atrial ectopy/tachycardia
Ventricular ectopy/tachycardia
Complete AV nodal block
Accessory pathway
Other
49
1
2
22
2
4
0
18
0
58
Hammersmith Hospital
Centre: Town/City: London
Local Area Team: Q71. London
Procedures registered with NICOR for 2013‐14 Total
354
Ablation Procedures
Ablation Targets reported
Atrial fibrillation
Atrial flutter
AVNRT
Atrial ectopy/tachycardia
Ventricular ectopy/tachycardia
Complete AV nodal block
Accessory pathway
Other
358
158
72
47
15
38
0
21
7
Harefield Hospital
Centre: Town/City: Uxbridge
Local Area Team: Q71. London
Procedures registered with NICOR for 2013‐14 Total
406
Ablation Procedures
Ablation Targets reported
Atrial fibrillation
Atrial flutter
AVNRT
Atrial ectopy/tachycardia
Ventricular ectopy/tachycardia
Complete AV nodal block
Accessory pathway
Other
432
208
49
77
28
23
10
29
3
Harley Street Clinic
Centre: Town/City: London
Local Area Team: Q71. London
Procedures registered with NICOR for 2013‐14 Total
423
Ablation Procedures
Ablation Targets reported
Atrial fibrillation
Atrial flutter
AVNRT
Atrial ectopy/tachycardia
Ventricular ectopy/tachycardia
Complete AV nodal block
Accessory pathway
Other
439
197
54
30
30
20
6
8
81
59
Kings College Hospital
Centre: Town/City: London
Local Area Team: Q71. London
Procedures registered with NICOR for 2013‐14 Total
279
Ablation Procedures
Ablation Targets reported
Atrial fibrillation
Atrial flutter
AVNRT
Atrial ectopy/tachycardia
Ventricular ectopy/tachycardia
Complete AV nodal block
Accessory pathway
Other
295
52
83
56
13
31
22
28
4
London Bridge Hospital
Centre: Town/City: London
Local Area Team: Q71. London
Procedures registered with NICOR for 2013‐14 Total
264
Ablation Procedures
Ablation Targets reported
Atrial fibrillation
Atrial flutter
AVNRT
Atrial ectopy/tachycardia
Ventricular ectopy/tachycardia
Complete AV nodal block
Accessory pathway
Other
267
168
42
23
6
7
8
9
1
Royal Brompton Hospital
Centre: Town/City: London
Local Area Team: Q71. London
Procedures registered with NICOR for 2013‐14 Total
902
Ablation Procedures
Ablation Targets reported
Atrial fibrillation
Atrial flutter
AVNRT
Atrial ectopy/tachycardia
Ventricular ectopy/tachycardia
Complete AV nodal block
Accessory pathway
Other
999
346
168
110
154
79
20
81
16
60
St Georges Hospital
Centre: Town/City: London
Local Area Team: Q71. London
Procedures registered with NICOR for 2013‐14 Total
188
Ablation Procedures
Ablation Targets reported
Atrial fibrillation
Atrial flutter
AVNRT
Atrial ectopy/tachycardia
Ventricular ectopy/tachycardia
Complete AV nodal block
Accessory pathway
Other
208
154
26
7
14
6
0
1
0
St Marys Hospital Paddington
Centre: Town/City: London
Local Area Team: Q71. London
Procedures registered with NICOR for 2013‐14 Total
51
Ablation Procedures
Ablation Targets reported
Atrial fibrillation
Atrial flutter
AVNRT
Atrial ectopy/tachycardia
Ventricular ectopy/tachycardia
Complete AV nodal block
Accessory pathway
Other
51
0
12
32
2
0
0
5
0
St Thomas Hospital
Centre: Town/City: London
Local Area Team: Q71. London
Procedures registered with NICOR for 2013‐14 Total
506
Ablation Procedures
Ablation Targets reported
Atrial fibrillation
Atrial flutter
AVNRT
Atrial ectopy/tachycardia
Ventricular ectopy/tachycardia
Complete AV nodal block
Accessory pathway
Other
550
213
98
64
53
33
29
46
3
61
University College Hospital
Centre: Town/City: London
Local Area Team: Q71. London
Procedures registered with NICOR for 2013‐14 Total
598
Ablation Procedures
Ablation Targets reported
Atrial fibrillation
Atrial flutter
AVNRT
Atrial ectopy/tachycardia
Ventricular ectopy/tachycardia
Complete AV nodal block
Accessory pathway
Other
636
276
156
49
48
42
8
41
5
Wellington Hospital North
Centre: Town/City: London
Local Area Team: Q71. London
Procedures registered with NICOR for 2013‐14 Total
249
Ablation Procedures
Ablation Targets reported
Atrial fibrillation
Atrial flutter
AVNRT
Atrial ectopy/tachycardia
Ventricular ectopy/tachycardia
Complete AV nodal block
Accessory pathway
Other
243
69
80
38
20
14
4
14
0
62
Scotland
Edinburgh Royal Infirmary
Centre: Town/City: Edinburgh
Local Area Team: Scotland
Procedures registered with NICOR for 2013‐14 Total
361
Ablation Procedures
Ablation Targets reported
Atrial fibrillation
Atrial flutter
AVNRT
Atrial ectopy/tachycardia
Ventricular ectopy/tachycardia
Complete AV nodal block
Accessory pathway
Other
361
68
70
104
27
17
18
54
3
Golden Jubilee Hospital
Centre: Town/City: Glasgow
Local Area Team: Scotland
Procedures registered with NICOR for 2013‐14 Total
390
Ablation Procedures
Ablation Targets reported
Atrial fibrillation
Atrial flutter
AVNRT
Atrial ectopy/tachycardia
Ventricular ectopy/tachycardia
Complete AV nodal block
Accessory pathway
Other
408
122
88
91
12
11
17
58
3
63
South Wales
Morriston Hospital
Centre: Town/City: Swansea
Local Area Team: South Wales
Procedures registered with NICOR for 2013‐14 Total
99
Ablation Procedures
Ablation Targets reported
Atrial fibrillation
Atrial flutter
AVNRT
Atrial ectopy/tachycardia
Ventricular ectopy/tachycardia
Complete AV nodal block
Accessory pathway
Other
100
0
16
50
0
0
5
27
1
University Hospital of Wales
Centre: Town/City: Cardiff
Local Area Team: South Wales
Procedures registered with NICOR for 2013‐14 Total
224
Ablation Procedures
Ablation Targets reported
Atrial fibrillation
Atrial flutter
AVNRT
Atrial ectopy/tachycardia
Ventricular ectopy/tachycardia
Complete AV nodal block
Accessory pathway
Other
250
40
77
54
4
4
25
42
1
64