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Outcomes and Anticoagulation Use After Catheter Ablation for Atrial Fibrillation
James V Freeman1, Peter Shrader2, Karen S Pieper2
1Yale University School of Medicine, New Haven, CT (J.V.F.).
Insights
Atrial fibrillation catheter ablation showed no difference in death rates compared to antiarrhythmic drugs. However, oral anticoagulation is often stopped post-ablation, increasing stroke risk.
Area of Science:
- Cardiology
- Electrophysiology
Background:
- Atrial fibrillation (AF) catheter ablation versus antiarrhythmic therapy outcomes are debated.
- Guidelines suggest continuing oral anticoagulation (OAC) post-ablation for stroke risk, but real-world data is limited.
Purpose of the Study:
- To compare outcomes of AF catheter ablation versus antiarrhythmic medication alone.
- To assess oral anticoagulation (OAC) patterns after AF ablation.
Main Methods:
- A propensity score-matched cohort from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation.
- Compared outcomes including death, MI, stroke, bleeding, and hospitalization.
- Used Cox proportional hazards regression to analyze AF ablation association with outcomes.
Main Results:
- No significant difference in all-cause/cardiovascular death or major adverse events between AF ablation and antiarrhythmic medication groups.
- AF catheter ablation was linked to increased all-cause hospitalization, especially within 3 months post-procedure.
- 23% of high-stroke-risk patients discontinued OAC after ablation, with a median discontinuation time of 6.2 months.
Conclusions:
- AF catheter ablation and antiarrhythmic medications have similar adjusted rates of death.
- OAC discontinuation post-ablation is common, despite guidelines recommending continued stroke prevention for at-risk patients.
Background:
Studies evaluating the effects of atrial fibrillation (AF) catheter ablation versus antiarrhythmic therapy on outcomes have shown mixed results. In addition, guidelines recommend continuing oral anticoagulation (OAC) after ablation for those at risk of stroke, but real-world data are lacking.
Methods:
We evaluated outcomes including death, myocardial infarction, stroke or systemic embolism, intracranial bleeding, major bleeding, and hospitalization in patients undergoing AF ablation compared with a propensity score matched cohort of patients treated with anti-arrhythmic medications only in the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation registries. Cox proportional hazards regression was performed to evaluate the association between AF ablation and outcomes. We then evaluated patterns of treatment with OAC among AF ablation patients.
Results:
Among 21 595 patients, 1190 (6%) underwent de novo AF ablation. Our propensity score-matched cohort included 1087 patients who underwent AF ablation matched 1:1 with 1087 patients treated with antiarrhythmic medications only. There were no significant differences in the risk of all-cause and cardiovascular death, and most other major adverse cardiovascular and neurological events. AF catheter ablation was associated with an increased risk of all-cause hospitalization during follow-up (hazard ratio, 1.24 [95% CI, 1.05-1.46]), particularly in the first 3 months (the standard blanking period) after the procedure. Among those who underwent AF ablation with a CHA2DS2 VASc score ≥2 for men and ≥3 for women, 23% had OAC discontinued after ablation. Among those who discontinued OAC, the median time to discontinuation was 6.2 months.
Conclusions:
In this large US national registry, we found no difference in adjusted rates of cardiovascular or all-cause death between patients treated with AF catheter ablation and antiarrhythmic medications only. Notably, discontinuation of OAC after ablation remains relatively common despite guideline recommendations for continued stroke prevention therapy in patients at risk of stroke.
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