Catheter ablation for atrial fibrillation is associated with lower incidence of stroke and death: Data from Swedish health registries

Abstract

Aim It is unclear if catheter ablation for atrial fibrillation (AF) affects the prognosis or merely is a symptomatic treatment. The aim is to study the association between ablation for AF, ischaemic stroke, and mortality Methods We identified all 361 913 patients with a diagnosis of AF in the Swedish Patient Register. During a 7-year period, 5176 and results AF ablations were performed among 4278 individuals. Patients who had undergone catheter ablation were younger (58.7 vs. 74.7 years, P, 0.001) and healthier (mean CHA2DS2-VASc scores 1.5 + 1.4 vs. 3.6 + 1.9, P, 0.001) than other patients with AF. Propensity score matching was used to construct two cohorts of equal size (n ¼ 2836) with similar characteristics in 51 dimensions. Mean follow-up was 4.4 + 2.0 years (minimum 1 year). In the ablated group, 78 patients suffered ischaemic stroke compared with 112 in the non-ablated (annual rates 0.70 vs. 1.0%, P ¼ 0.013). A total of 88 ablated and 184 non-ablated patients died (annual rates 0.77 vs. 1.62%, P, 0.001). After multivariable adjustments, catheter ablation was associated with lower risk of ischaemic stroke [hazard ratio (HR) 0.69, 95% confidence interval (CI) 0.51 - 0.93) and with lower mortality risk (HR 0.50, 95% CI 0.37 - 0.62). Stroke reduction was most pronounced among patients with CHA2DS2-VASc score ≥2 (HR 0.39, 95% CI 0.19 - 0.78) and among patients without new cardioversions beyond 6 months after the ablation (HR 0.68, 95% CI 0.48 - 0.97) Conclusion Ablation may be associated with lower incidence of ischaemic stroke and death in patients with AF. This beneficial finding appears more pronounced in patients with higher thromboembolic risk.