Leif Friberg1, Fariborz Tabrizi2, Anders Englund2. 1. Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden Department of Cardiology, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden leif.friberg@ki.se. 2. Department of Clinical Sciences, South Hospital, Karolinska Institute, Stockholm, Sweden Arrhythmia Center Stockholm, Stockholm, Sweden.
Abstract
AIM: It is unclear if catheter ablation for atrial fibrillation (AF) affects the prognosis or merely is a symptomatic treatment. The aim is to study the association between ablation for AF, ischaemic stroke, and mortality. METHODS AND RESULTS: We identified all 361 913 patients with a diagnosis of AF in the Swedish Patient Register. During a 7-year period, 5176 AF ablations were performed among 4278 individuals. Patients who had undergone catheter ablation were younger (58.7 vs. 74.7 years, P < 0.001) and healthier (mean CHA2DS2-VASc scores 1.5 ± 1.4 vs. 3.6 ± 1.9, P < 0.001) than other patients with AF. Propensity score matching was used to construct two cohorts of equal size (n = 2836) with similar characteristics in 51 dimensions. Mean follow-up was 4.4 ± 2.0 years (minimum 1 year). In the ablated group, 78 patients suffered ischaemic stroke compared with 112 in the non-ablated (annual rates 0.70 vs. 1.0%, P = 0.013). A total of 88 ablated and 184 non-ablated patients died (annual rates 0.77 vs. 1.62%, P < 0.001). After multivariable adjustments, catheter ablation was associated with lower risk of ischaemic stroke [hazard ratio (HR) 0.69, 95% confidence interval (CI) 0.51-0.93) and with lower mortality risk (HR 0.50, 95% CI 0.37-0.62). Stroke reduction was most pronounced among patients with CHA2DS2-VASc score ≥2 (HR 0.39, 95% CI 0.19-0.78) and among patients without new cardioversions beyond 6 months after the ablation (HR 0.68, 95% CI 0.48-0.97). CONCLUSION: Ablation may be associated with lower incidence of ischaemic stroke and death in patients with AF. This beneficial finding appears more pronounced in patients with higher thromboembolic risk. Published on behalf of the European Society of Cardiology. All rights reserved.
AIM: It is unclear if catheter ablation for atrial fibrillation (AF) affects the prognosis or merely is a symptomatic treatment. The aim is to study the association between ablation for AF, ischaemic stroke, and mortality. METHODS AND RESULTS: We identified all 361 913 patients with a diagnosis of AF in the Swedish Patient Register. During a 7-year period, 5176 AF ablations were performed among 4278 individuals. Patients who had undergone catheter ablation were younger (58.7 vs. 74.7 years, P < 0.001) and healthier (mean CHA2DS2-VASc scores 1.5 ± 1.4 vs. 3.6 ± 1.9, P < 0.001) than other patients with AF. Propensity score matching was used to construct two cohorts of equal size (n = 2836) with similar characteristics in 51 dimensions. Mean follow-up was 4.4 ± 2.0 years (minimum 1 year). In the ablated group, 78 patients suffered ischaemic stroke compared with 112 in the non-ablated (annual rates 0.70 vs. 1.0%, P = 0.013). A total of 88 ablated and 184 non-ablated patients died (annual rates 0.77 vs. 1.62%, P < 0.001). After multivariable adjustments, catheter ablation was associated with lower risk of ischaemic stroke [hazard ratio (HR) 0.69, 95% confidence interval (CI) 0.51-0.93) and with lower mortality risk (HR 0.50, 95% CI 0.37-0.62). Stroke reduction was most pronounced among patients with CHA2DS2-VASc score ≥2 (HR 0.39, 95% CI 0.19-0.78) and among patients without new cardioversions beyond 6 months after the ablation (HR 0.68, 95% CI 0.48-0.97). CONCLUSION: Ablation may be associated with lower incidence of ischaemic stroke and death in patients with AF. This beneficial finding appears more pronounced in patients with higher thromboembolic risk. Published on behalf of the European Society of Cardiology. All rights reserved.
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