Catheter Ablation for Atrial Fibrillation and Outcomes

Study Questions:

Is catheter ablation of atrial fibrillation (AF) associated with improved outcomes?

Methods:

The study subjects were culled from all patients with a diagnosis of AF in the Swedish national registry from the years 2006 and 2012. Patients who underwent catheter ablation of AF were then identified, after excluding those with valvular heart disease, Wolff-Parkinson-White, atrial flutter, pacemaker/defibrillator, death within 30 days of hospitalization, and surgical ablation. Subgroups of patients were also identified among patients who did and did not undergo catheter ablation by propensity score matching.

Results:

A total of 3,120 and 295,877 patients who did and did not undergo catheter ablation of AF, respectively, were identified. There were major differences in age (59 vs. 75 years), comorbidities (CHA2DS2-VASc score 1.5 vs. 3.6), and use of oral anticoagulants (86% vs. 44%) and antiarrhythmic medications (58% vs. 8%), respectively. Multivariable analysis showed that age <65 years, college education, higher income, and use of anticoagulant and arrhythmic medications were associated with the likelihood of undergoing catheter ablation. After propensity matching (for the likelihood of undergoing ablation), 2,496 patients were identified in each group. During a mean follow-up of 4 years, the annual risk of stroke (0.7 vs. 1.0%, p = 0.01) and death (0.8 vs. 1.6%, p = 0.001) was lower in the ablation group.

Conclusions:

In this observational study of patients with AF, the risk of adverse outcomes such as stroke and death were lower among patients who underwent catheter ablation as compared to those who did not.

Perspective:

Patients with AF face a long-term risk of heart failure, stroke, and premature death. Large randomized studies utilizing pharmacotherapy in an attempt to achieve sinus rhythm have been disappointing. On the other hand, ablation studies have demonstrated an improvement in symptoms and ejection fraction, and have also suggested improved long-term outcomes. The findings of this study are consistent with the earlier studies, and also reassuring. Ultimately, randomized studies will be required to demonstrate definitively the superiority of catheter ablation with respect to hard endpoints.

Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Anticoagulation Management and Atrial Fibrillation, Implantable Devices, EP Basic Science, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure

Keywords: Anti-Arrhythmia Agents, Anticoagulants, Arrhythmias, Cardiac, Atrial Fibrillation, Catheter Ablation, Heart Failure, Mortality, Premature, Stroke, Outcome Assessment (Health Care)


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