In a new study, catheter ablation reduced the risk for stroke among patients with atrial fibrillation.
T. Jared Bunch, MD, of the Intermountain Heart Institute in Salt Lake City, and colleagues also found that a patient with AF who underwent ablation had a similar long-term risk for stroke to a patient without AF, regardless of CHADS2 risk score.
The researchers enrolled 37,908 patients (mean age, 65 years) from the Intermountain Atrial Fibrillation Study Registry. Of those, 4,212 had AF and underwent ablation, 16,848 had AF and had not undergone ablation, and 16,848 had no history of AF. Each patient who underwent AF ablation was matched with four patients of the same sex and similar age who had AF but had not undergone ablation and four patients of the same sex and similar age who did not have AF.
The primary outcome was stroke. Mean follow-up was 2.9 years.
Among patients, 4.4% of those without AF, 6.3% of those with AF but without ablation, and 4.5% of those who had undergone ablation for AF experienced a prior stroke (P<.0001). At 1 year, 3.5% of AF patients who did not have ablation experienced a stroke vs. 1.4% of those with AF who underwent ablation and 1.4% of those without AF (P<.0001).
Regardless of age or CHADS2 profile, AF patients with ablation had a lower long-term risk for stroke compared with AF patients without ablation, with the greatest difference observed in patients aged younger than 60 years. Long-term risk for stroke among AF patients with ablation was similar to patients with no history of AF, Bunch and colleagues found.
“These data in part suggest that ablation, and the process and subsequent care associated with ablation, can favorably affect the natural history and consequences of AF,” the researchers wrote. “However, it must be emphasized that since these data are derived from a multicenter observation design, we do not have accurate data on long-term success rates of AF recurrence, particularly, subclinical AF.”
As to why ablation may have such a positive effect, the researchers wrote, “It is possible that ablation early in the disease process, by either maintaining sinus rhythm or significantly reducing AF burden, can stop the progression of the structural, anatomic, and functional changes in the atrium. This postulate is supported by serial echocardiographic assessments of atrial function over time after ablation.”
Disclosure: See the full study for a list of the researchers’ relevant financial disclosures.