Association between catheter ablation of atrial fibrillation and mortality or stroke

Area of Science:

• Cardiology
• Electrophysiology
• Public Health

Background:

• Atrial fibrillation (AF) management aims to reduce symptomatic burden and prevent adverse outcomes.
• The long-term impact of catheter ablation on mortality and stroke risk in AF patients remains incompletely understood.
• Comparing catheter ablation to medical management is crucial for guiding treatment decisions.

Purpose of the Study:

• To investigate whether catheter ablation for atrial fibrillation reduces the risk of all-cause mortality or stroke compared to medical management.
• To evaluate the long-term effectiveness of catheter ablation in a large, real-world patient cohort.

Main Methods:

• Retrospective analysis of 5,628 patients undergoing first-time catheter ablation for AF (2008-2018).
• A control group of 48,676 AF patients without prior stroke was selected from the Swedish National Patient Register.
• Propensity score matching created two comparable cohorts (n=3,955 each) to minimize baseline characteristic differences.

Main Results:

• The catheter ablation group exhibited better health status, higher income, and more frequent university education.
• After propensity score matching, catheter ablation was associated with a 42% reduced risk of the composite endpoint (all-cause mortality or stroke) (HR 0.58, 95% CI 0.48-0.69).
• This reduction was primarily driven by a significant decrease in all-cause mortality (HR 0.51, 95% CI 0.41-0.63), with a non-significant trend towards stroke reduction.

Conclusions:

• Catheter ablation for atrial fibrillation is associated with a significant reduction in the combined risk of all-cause mortality and stroke.
• The observed benefit is largely attributable to a marked decrease in all-cause mortality.
• These findings support catheter ablation as a potentially life-saving intervention for select AF patients.