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Published on: May 26, 2015
Thromboembolic events 7-11 years after catheter ablation of atrial fibrillation
Van Nam Tran1, Elena Tessitore, Pascale Gentil-Baron
1Cardiology Division, University Hospital of Geneva, Geneva, Switzerland.
Insights
Catheter ablation for atrial fibrillation (AF) shows low long-term thromboembolic event (TE) rates, even in patients with high stroke risk scores. Patients with CHA2DS2-VASc scores of 2 or higher should continue anticoagulation post-ablation.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Interventions
Background:
- Long-term outcomes of catheter ablation for atrial fibrillation (AF) remain largely unknown.
- Assessing thromboembolic event (TE) risk and outcomes beyond 6 years is crucial.
Purpose of the Study:
- To evaluate the long-term safety and efficacy of AF catheter ablation.
- To determine the risk of TE and other adverse events after AF ablation at extended follow-up.
Main Methods:
- A cohort of 264 patients undergoing AF ablation between 2002-2005 was followed.
- Long-term follow-up included questionnaires, cardiac rhythm monitoring, and echocardiography.
Main Results:
- 164 patients completed a mean 9.1-year follow-up.
- The TE rate was 0.41 per 100 patient-years; stroke occurred in 0.14 per 100 patient-years.
- Stable sinus rhythm was achieved in 68% of patients; predictors of recurrence included high CHA2DS2-VASc scores and amiodarone use.
Conclusions:
- AF catheter ablation demonstrates low long-term TE rates, potentially lower than anticoagulation alone.
- Patients with a CHA2DS2-VASc score of 2 or higher require continued anticoagulation therapy.
Background:
The results of catheter ablation of atrial fibrillation (AF) beyond 6 years remain unknown. The goal of this study is to assess the risk of thromboembolic events (TEs) and outcomes of AF ablation at long-term follow-up (FU).
Methods:
All patients who had AF ablation from 2002 until 2005 in our center were contacted for a FU including a questionnaire, cardiac rhythm monitoring, and transthoracic echocardiography.
Results:
Among the 264 eligible patients, 164 (62%) completed the study. The mean FU was 9.1 years (7.7-10.5). Seven patients had a TE during FU (event ratio 0.41 per 100 patient years [PY]) and their mean CHA2DS2-VASc score was 3.1 ± 1.3. Two patients died from stroke (0.14 per 100 PY) and five of the seven were considered in sinus rhythm (SR) and were off anticoagulation at the time of event. Prior to ablation, 13 patients had history of TE, and only one had a TE during FU. Overall, 14 deaths were documented (0.58 per 100 PY). Stable SR was present in 111 patients (68% of 164 patients) after 1.5 ± 0.6 procedures/patient. Univariate analysis showed that dyslipidemia (odds ratio [OR] = 2.95, P = 0.003), CHA2DS2-VASc ≥2 (OR = 3.22, P = 0.001), and amiodarone (OR = 5.64, P < 0.001) were predictors of long-term recurrence. Multivariate analysis showed that only CHA2DS2-VASc ≥2 (OR = 2.67, P = 0.023) and amiodarone (OR = 4.62, P = 0.001) were predictors.
Conclusions:
Our study shows low TE rates 9 years after ablation of AF that are lower than published data for AF patients with anticoagulation only. AF patients with a CHA2DS2-VASc ≥2 should, however, be maintained on anticoagulation.
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