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Maintenance of sinus rhythm with an ablation strategy in patients with atrial fibrillation is associated with a lower risk of stroke and death
  1. Ross J Hunter1,
  2. James McCready2,
  3. Ihab Diab1,
  4. Stephen P Page1,
  5. Malcolm Finlay2,
  6. Laura Richmond1,
  7. Antony French3,
  8. Mark J Earley1,4,
  9. Simon Sporton1,4,
  10. Michael Jones5,
  11. Jubin P Joseph5,
  12. Yaver Bashir5,
  13. Tim R Betts5,
  14. Glyn Thomas3,
  15. Andrew Staniforth6,
  16. Geoffrey Lee7,
  17. Peter Kistler7,
  18. Kim Rajappan5,
  19. Anthony Chow2,
  20. Richard J Schilling1,4
  1. 1Department of Cardiology Research, Barts and The London NHS Trust, London, UK
  2. 2Department of Cardiology, The Heart Hospital, London, UK
  3. 3Bristol Heart Institute, Bristol, UK
  4. 4The London AF Centre, London Bridge Hospital, London, UK
  5. 5John Radcliffe Hospital, Oxford, UK
  6. 6NUH Hospitals Trust, Nottingham, UK
  7. 7The Baker Heart Research Institute, Melbourne, Australia
  1. Correspondence to Professor Richard J Schilling, Cardiology Department, Barts and The London NHS Trust QMUL, St Bartholomew's Hospital, London EC1A 7BE, UK; r.schilling{at}qmul.ac.uk

Abstract

Objective To investigate whether catheter ablation of atrial fibrillation (AF) reduces stroke rate or mortality.

Methods An international multicentre registry was compiled from seven centres in the UK and Australia for consecutive patients undergoing catheter ablation of AF. Long-term outcomes were compared with (1) a cohort with AF treated medically in the Euro Heart Survey, and (2) a hypothetical cohort without AF, age and gender matched to the general population. Analysis of stroke and death was carried out after the first procedure (including peri-procedural events) regardless of success, on an intention-to-treat basis.

Results 1273 patients, aged 58±11 years, 56% paroxysmal AF, CHADS2 score 0.7±0.9, underwent 1.8±0.9 procedures. Major complications occurred in 5.4% of procedures, including stroke/TIA in 0.7%. Freedom from AF following the last procedure was 85% (76% off antiarrhythmic drugs) for paroxysmal AF, and 72% (60% off antiarrhythmic drugs) for persistent AF. During 3.1 (1.0–9.6) years from the first procedure, freedom from AF predicted stroke-free survival on multivariate analysis (HR=0.30, CI 0.16 to 0.55, p<0.001). Rates of stroke and death were significantly lower in this cohort (both 0.5% per patient-year) compared with those treated medically in the Euro Heart Survey (2.8% and 5.3%, respectively; p<0.0001). Rates of stroke and death were no different from those of the general population (0.4% and 1.0%, respectively).

Conclusion Restoration of sinus rhythm by catheter ablation of AF is associated with lower rates of stroke and death compared with patients treated medically.

  • AF
  • catheter ablation
  • outcome
  • mortality
  • stroke
  • atrial fibrillation
  • arrhythmias
  • radiofrequency ablation (RFA)
  • ventricular tachycardia
  • ventricular fibrillation
  • ECG
  • stroke
  • ICD
  • atrial arrhythmias
  • radiofrequency catheter ablation
  • sudden cardiac death
  • pacing
  • electrophysiology
  • atrial flutter
  • EBM
  • invasive electrophysiology
  • arrhythmic right ventricular dysplasia
  • WPW syndrome
  • implantable cardioverter defibrillator (ICD)
  • sudden cardiac death

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Footnotes

  • Funding RJH is supported by a British Heart Foundation grant (PG/08/130). This work was facilitated by Barts and The London NHS Trust NIHR Biomedical Research Unit.

  • Competing interests None.

  • Ethics approval This was retrospective analysis of registry data.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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