TY - JOUR

T1 - Catheter ablation and mortality, stroke and heart failure readmission with atrial fibrillation

AU - Pallisgaard, Jannik Langtved

AU - Lock Hansen, Morten

AU - Schjerning, Anne Marie

AU - Johannessen, Arne

AU - Gerds, Thomas Alexander

AU - Gustafsson, Finn

AU - Gislason, Gunnar Hilmar

AU - Torp-Pedersen, Chriatian

AU - Jacobsen, Peter Karl

AU - Kristensen, Søren Lund

AU - Koeber, Lars

AU - Munch, Anders

AU - Schou, Morten

PY - 2020

Y1 - 2020

N2 - Background: Recent randomised clinical trials have suggested prognostic benefits of catheter ablation in highly selected patients with atrial fibrillation (AF) and heart failure (HF). Objectives: This study sought to identify the treatment effect associated with catheter ablation in a broad population of patients with AF and HF. Methods: Through nationwide administrative registers in Denmark, we estimated the 2-year average treatment effect (ATE) of catheter ablation for AF on a composite endpoint of HF readmission, stroke and all-cause mortality at 1-year and 5-year landmark analyses. The primary cohort was patients with AF before HF, and the second cohort of patients with HF before AF. Results: A total of 13 756 patients were included with 9904 patients in the primary cohort, and 3852 in the secondary. An ATE (95% CI) reduction of the composite endpoint of 7.0% (4.5% to 9.5%) was observed in the primary cohort and 11.8% (6.0% to 17.6%) in the secondary in the 1-year landmark analysis with a reduction in all-cause mortality of 5.8% (3.7%-7.8%) and 6.3% (0.9%-11.7%), respectively. At the 5-year landmark, catheter ablation was associated with reductions in the composite endpoint and all-cause mortality in the primary (4.7% (2.3% to 7.2%), and 3.6% (1.0% to 6.3%), respectively), but not in the secondary cohort. Conclusions: Ablation was associated with decreased risk of HF readmission, stroke and all-cause mortality in patients with AF and HF. The effect is most substantial in patients with AF before HF and with catheter ablation after 1 year from the diagnosis of both conditions.

AB - Background: Recent randomised clinical trials have suggested prognostic benefits of catheter ablation in highly selected patients with atrial fibrillation (AF) and heart failure (HF). Objectives: This study sought to identify the treatment effect associated with catheter ablation in a broad population of patients with AF and HF. Methods: Through nationwide administrative registers in Denmark, we estimated the 2-year average treatment effect (ATE) of catheter ablation for AF on a composite endpoint of HF readmission, stroke and all-cause mortality at 1-year and 5-year landmark analyses. The primary cohort was patients with AF before HF, and the second cohort of patients with HF before AF. Results: A total of 13 756 patients were included with 9904 patients in the primary cohort, and 3852 in the secondary. An ATE (95% CI) reduction of the composite endpoint of 7.0% (4.5% to 9.5%) was observed in the primary cohort and 11.8% (6.0% to 17.6%) in the secondary in the 1-year landmark analysis with a reduction in all-cause mortality of 5.8% (3.7%-7.8%) and 6.3% (0.9%-11.7%), respectively. At the 5-year landmark, catheter ablation was associated with reductions in the composite endpoint and all-cause mortality in the primary (4.7% (2.3% to 7.2%), and 3.6% (1.0% to 6.3%), respectively), but not in the secondary cohort. Conclusions: Ablation was associated with decreased risk of HF readmission, stroke and all-cause mortality in patients with AF and HF. The effect is most substantial in patients with AF before HF and with catheter ablation after 1 year from the diagnosis of both conditions.

KW - atrial fibrillation

KW - heart failure

KW - radiofrequency ablation

KW - stroke

U2 - 10.1136/openhrt-2020-001369

DO - 10.1136/openhrt-2020-001369

M3 - Journal article

C2 - 33168641

AN - SCOPUS:85095984405

VL - 7

JO - Open Heart

JF - Open Heart

SN - 2398-595X

IS - 2

M1 - e001369

ER -