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Long-term outcomes of catheter ablation compared with medical therapy in atrial fibrillation
Yong-Giun Kim1, Sunjidatul Islam2, Douglas C Dover2
1Department of Medicine, QEII Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada; Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
Insights
Catheter ablation (CA) for atrial fibrillation (AF) significantly reduces long-term cardiovascular risks compared to medical therapy. This study shows CA offers better outcomes for AF patients, lowering death, heart failure hospitalizations, and stroke risk.
Area of Science:
- Cardiology
- Medical Interventions
- Atrial Fibrillation Management
Background:
- Long-term cardiovascular outcomes of catheter ablation (CA) versus medical therapy for atrial fibrillation (AF) are not well-established.
- Understanding comparative effectiveness is crucial for patient management.
Purpose of the Study:
- To compare the long-term cardiovascular outcomes of CA against medical therapy in a large population-based cohort of AF patients.
- To assess the association between CA and adverse events including death, heart failure hospitalization, and stroke.
Main Methods:
- Utilized Alberta administrative data from October 2008 to March 2018, including 39,966 AF patients.
- Classified patients into CA, rate control, or rhythm control medication groups.
- Adjusted for age, sex, comorbidities, and baseline medications in multivariable analysis.
Main Results:
- Catheter ablation (CA) group had a lower primary outcome incidence (4.0/100 person-years) versus rate control (8.7) and rhythm control (6.8).
- Multivariable analysis revealed higher risks for rate control (HR 1.28) and rhythm control (HR 1.21) compared to CA.
- Median follow-up was 6.3 years.
Conclusions:
- Catheter ablation (CA) is associated with reduced long-term adverse cardiovascular outcomes in atrial fibrillation (AF) patients compared to medical therapy.
- Findings support CA as a potentially superior treatment strategy for managing AF and its associated cardiovascular risks.
Background:
The long-term effects of catheter ablation (CA) compared with medical therapy on cardiovascular outcomes for atrial fibrillation (AF) remain undetermined.
Objective:
Using a population-based cohort, we sought to determine what the association between CA and medical therapy was on these outcomes.
Methods:
By use of Alberta administrative data, patients with AF as the primary diagnosis during hospitalization, emergency department visit, or physician visit were included between October 1, 2008, and March 31, 2018. Based on therapy received, patients were assigned to categories of CA, rate control, or rhythm control with medication. The association of treatment with the primary composite outcome of all-cause death, hospitalization for heart failure, or stroke was examined after adjustment for age, sex, comorbidities, and baseline medications.
Results:
Of 39,966 treated AF patients, 2077 (5.2%), 29,467 (73.7%), and 8422 (21.1%) were treated with CA, rate control, and rhythm control with medication, respectively. Patients in the CA group had a lower incidence of the primary outcome (4.0/100 person-years) compared with the rate control group (8.7/100 person-years) or the rhythm control with medication group (6.8/100 person-years) during a median follow-up of 6.3 years. In multivariable analysis, compared with CA, both rate control (hazard ratio, 1.28; 95% confidence interval, 1.09-1.50) and rhythm control with medication (hazard ratio, 1.21; 95% confidence interval, 1.03-1.43) were associated with a higher risk of the primary outcome.
Conclusion:
In this cohort study, patients who received CA demonstrated a reduction in the risk of long-term adverse cardiovascular outcomes compared with medical therapy in patients with AF, providing some data to indicate the effects of CA in the long-term.
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