Walid Saliba1, Jorge E Schliamser2, Idit Lavi3, Ofra Barnett-Griness3, Naomi Gronich4, Gad Rennert5. 1. Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Clalit Health Services, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel. Electronic address: saliba_wa@clalit.org.il. 2. Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, Clalit Health Services, Haifa, Israel. 3. Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Clalit Health Services, Haifa, Israel; Statistical Unit, Lady Davis Carmel Medical Center, Clalit Health Services, Haifa, Israel. 4. Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Clalit Health Services, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel. 5. Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Clalit Health Services, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel; Department of Epidemiology and Disease Prevention, Office of the Chief Physician, Clalit Health Services Headquarters, Tel Aviv, Israel.
Abstract
BACKGROUND: Catheter ablation reduces recurrence of atrial fibrillation and improves quality of life. Only few studies have assessed the effect of catheter ablation on long-term outcomes. OBJECTIVE: The purpose of this study was to assess the association between catheter ablation and risk of stroke and mortality in patients with atrial fibrillation. METHODS: Using the computerized database of the largest health maintenance organization in Israel, we identified all adults hospitalized with a primary diagnosis of atrial fibrillation between January 1, 2005, and December 31, 2015. Of them, a total of 969 individuals who underwent catheter ablation during the same admission were matched, on the basis of the propensity of having ablation, with 3772 individuals who did not undergo catheter ablation during the same period. The cohort was followed for the occurrence of stroke or transient ischemic attack (TIA) and mortality until June 30, 2016. RESULTS: Overall, 3953 (83.4%) of patient in both groups had a CHA2DS2VASc score of 2 or greater. The incidence rate of stroke/TIA was 2.10 and 3.26 per 100 person-years in the ablation group and the nonablation group, respectively. The crude hazard ratio [HR] for stroke/TIA was 0.61 (95% confidence interval [CI] 0.48-0.79) in the ablation group compared with the nonablation group. The results were similar after controlling for CHA2DS2-VASc score (HR 0.58; 95% CI 0.43-0.72). The adjusted HRs for stroke alone, TIA alone, and mortality were 0.62 (95% CI 0.47-0.82), 0.47 (95% CI 0.20-0.78), and 0.57 (95% CI 0.47-0.66), respectively. CONCLUSION: Catheter ablation of atrial fibrillation is associated with a decreased risk of stroke/TIA and mortality in predominantly patients with a high CHA2DS2-VASc score.
BACKGROUND: Catheter ablation reduces recurrence of atrial fibrillation and improves quality of life. Only few studies have assessed the effect of catheter ablation on long-term outcomes. OBJECTIVE: The purpose of this study was to assess the association between catheter ablation and risk of stroke and mortality in patients with atrial fibrillation. METHODS: Using the computerized database of the largest health maintenance organization in Israel, we identified all adults hospitalized with a primary diagnosis of atrial fibrillation between January 1, 2005, and December 31, 2015. Of them, a total of 969 individuals who underwent catheter ablation during the same admission were matched, on the basis of the propensity of having ablation, with 3772 individuals who did not undergo catheter ablation during the same period. The cohort was followed for the occurrence of stroke or transient ischemic attack (TIA) and mortality until June 30, 2016. RESULTS: Overall, 3953 (83.4%) of patient in both groups had a CHA2DS2VASc score of 2 or greater. The incidence rate of stroke/TIA was 2.10 and 3.26 per 100 person-years in the ablation group and the nonablation group, respectively. The crude hazard ratio [HR] for stroke/TIA was 0.61 (95% confidence interval [CI] 0.48-0.79) in the ablation group compared with the nonablation group. The results were similar after controlling for CHA2DS2-VASc score (HR 0.58; 95% CI 0.43-0.72). The adjusted HRs for stroke alone, TIA alone, and mortality were 0.62 (95% CI 0.47-0.82), 0.47 (95% CI 0.20-0.78), and 0.57 (95% CI 0.47-0.66), respectively. CONCLUSION: Catheter ablation of atrial fibrillation is associated with a decreased risk of stroke/TIA and mortality in predominantly patients with a high CHA2DS2-VASc score.
Authors: Kevin G Graves; Victoria Jacobs; Heidi T May; Michael J Cutler; John D Day; T Jared Bunch Journal: Curr Treat Options Cardiovasc Med Date: 2018-01-24
Authors: Nikolaos Dagres; Tze-Fan Chao; Guilherme Fenelon; Luis Aguinaga; Daniel Benhayon; Emelia J Benjamin; T Jared Bunch; Lin Yee Chen; Shih-Ann Chen; Francisco Darrieux; Angelo de Paola; Laurent Fauchier; Andreas Goette; Jonathan Kalman; Lalit Kalra; Young-Hoon Kim; Deirdre A Lane; Gregory Y H Lip; Steven A Lubitz; Manlio F Márquez; Tatjana Potpara; Domingo Luis Pozzer; Jeremy N Ruskin; Irina Savelieva; Wee Siong Teo; Hung-Fat Tse; Atul Verma; Shu Zhang; Mina K Chung; William-Fernando Bautista-Vargas; Chern-En Chiang; Alejandro Cuesta; Gheorghe-Andrei Dan; David S Frankel; Yutao Guo; Robert Hatala; Young Soo Lee; Yuji Murakawa; Cara N Pellegrini; Claudio Pinho; David J Milan; Daniel P Morin; Elenir Nadalin; George Ntaios; Mukund A Prabhu; Marco Proietti; Lena Rivard; Mariana Valentino; Alena Shantsila Journal: J Arrhythm Date: 2018-03-23