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

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DOI

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  • Jannik Langtved Pallisgaard
  • Morten Lock Hansen
  • Anne-Marie Schjerning
  • Arne Johannessen
  • Thomas Alexander Gerds
  • Finn Gustafsson
  • Gunnar Hilmar Gislason
  • Chriatian Torp-Pedersen
  • Peter Karl Jacobsen
  • Søren Lund Kristensen
  • Lars Koeber
  • Anders Munch
  • Morten Schou
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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.

OriginalsprogEngelsk
TidsskriftOpen Heart
Vol/bind7
Udgave nummer2
ISSN2053-3624
DOI
StatusUdgivet - nov. 2020

Bibliografisk note

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

ID: 61262648