Maintenance of Sinus Rhythm With an Ablation Strategy in Patients With Atrial Fibrillation Is Associated With a Lower Risk of Stroke and Death

Study Questions:

Does catheter ablation (CA) of atrial fibrillation (AF) improve long-term outcomes?

Methods:

CA of AF (paroxysmal in 56%) was performed in 1,273 patients (mean age 58 years) enrolled in an ablation registry. Success was defined as freedom from AF/tachycardia after a 3-month blanking period. The rates of stroke and death were compared between patients with and without recurrent AF and between patients who underwent CA and a published cohort of patients with medically-treated AF. Outcomes also were compared with a hypothetical group of age/gender-matched individuals in the general population, based on United Kingdom national statistics.

Results:

The procedural major complication rate was 5.4%. The mean duration of follow-up after a mean of 1.8 procedures was 2.2 years. Freedom from AF was achieved in 85% of patients with paroxysmal AF and 72% with persistent AF. Freedom from AF was independently associated with a 70% reduction in stroke/mortality. The annual stroke and mortality rates (0.5% for each) were significantly lower in the CA patients than in the medically-treated cohort (2.8% and 5.3%, respectively), and similar to the stroke and mortality rates in the general population (0.4% and 1.0%, respectively).

Conclusions:

The authors concluded that successful CA of AF lowers the risk of stroke and death.

Perspective:

The AFFIRM study showed that maintenance of sinus rhythm was independently associated with reduced mortality, but that this effect was neutralized by the deleterious effects of antiarrhythmic drug therapy. Given the limitations of registry data and historical controls, the conclusions of this study are tentative, but the results suggest that maintenance of sinus rhythm without the need for antiarrhythmic drug therapy can improve outcomes.

Clinical Topics: Arrhythmias and Clinical EP, Dyslipidemia, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Lipid Metabolism

Keywords: Great Britain, Stroke, Follow-Up Studies, Fatty Acids, Brain Ischemia, Catheter Ablation, Tachycardia


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