Mortality and Cerebrovascular Events After Radiofrequency Catheter Ablation of Atrial Fibrillation | Journal Scan

Study Questions:

What is the impact of maintaining sinus rhythm (SR) after radiofrequency catheter ablation (RFA) of atrial fibrillation (AF) on the risk of cerebrovascular events (CVEs) and mortality during an extended 10-year follow-up?


RFA was performed in 3,058 patients (age 58 ± 10 years) with paroxysmal (n = 1,888) or persistent AF (n = 1,170). The effects of time-dependent rhythm status on CVEs and cardiac and all-cause mortality were assessed using multivariable Cox models adjusted for baseline and time-dependent variables during 11,347 patient-years of follow-up.


Independent predictors of a higher arrhythmia burden after RFA were age (estimated beta coefficient [β] = 0.017 per 10 years, 95% confidence interval [CI], 0.006-0.029; p = 0.003), left atrial (LA) diameter (β = 0.044 per 5-mm increase in LA diameter, 95% CI, 0.034-0.055; p < 0.0001), and persistent AF (β = 0.174, 95% CI, 0.147-0.201; p < 0.0001). CVEs and cardiac and all-cause mortality occurred in 71 (2.3%), 33 (1.1%), and 111 (3.6%), respectively. SR after RFA was associated with a significantly lower risk of cardiac mortality (hazard ratio [HR], 0.41; 95% CI, 0.20-0.84; p = 0.015). There was not a significant reduction in all-cause mortality (HR, 0.86; 95% CI, 0.58-1.29; p = 0.48) or CVEs (HR, 0.79; 95% CI, 0.48-1.29; p = 0.34) in patients who remained in SR after RFA.


The authors concluded that maintenance of SR after RFA is associated with a reduction in cardiovascular mortality in patients with AF.


This study reports that absence of symptomatic or documented recurrences of AF after RFA is associated with a significant 60% lower risk of cardiac mortality, irrespective of the blanking period or antiarrhythmic or anticoagulant drug use. However, maintenance of SR after RFA was not associated with a significant decrease in the risk of CVEs, irrespective of the blanking period or antiarrhythmic or anticoagulant drug use. Whether maintenance of SR would also lower the risk of all-cause mortality and CVEs, particularly in the absence of concomitant anticoagulant therapy, needs to be determined in large and long-term studies using continuous monitoring of the rhythm status.

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

Keywords: Cost of Illness, Heart Atria, Atrial Fibrillation, Catheter Ablation

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