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Five-year impact of catheter ablation for atrial fibrillation in patients with a prior history of stroke.
- Source :
-
Journal of cardiovascular electrophysiology [J Cardiovasc Electrophysiol] 2018 Feb; Vol. 29 (2), pp. 221-226. Date of Electronic Publication: 2017 Dec 13. - Publication Year :
- 2018
-
Abstract
- Background: Catheter ablation of atrial fibrillation (AF) is an established therapeutic rhythm approach. Patients with a prior history of a stroke (CVA) represent a unique high-risk population for recurrent thromboembolic events. The role of antiarrhythmic treatment on the natural history of stroke recurrence in these patients is not fully understood.<br />Methods: Three patient groups with a prior CVA and 5 years of follow-up were matched 1:3:3 by propensity score (±0.01): AF ablation patients receiving their first ablation (n  =  139), AF patients that did not receive an ablation (n  =  416), and CVA patients without clinical AF (n  =  416). Prior CVA was determined by medical chart review. Patients were followed for outcomes of recurrent CVA, heart failure, and death.<br />Results: The average age of the population was 69 ± 11 years and 51% male. AF ablation patients had higher rates of hypertension and heart failure (P < 0.0001), but diabetes prevalence was similar between the groups (P  =  0.5). Note that 5-year risk of CVA (HR  =  2.26, P < 0.0001) and death (HR  =  2.43, P < 0.0001) were higher in the AF, no ablation group compared those that were ablated. When comparing AF, ablation to no AF patients, there was not a significant difference in 5-year risk of for CVA (HR  =  0.82, P  =  0.39) and death (HR  =  0.92, P  =  0.70); however, heart failure risk was increased (HR  =  3.08, P  =  0.001).<br />Conclusion: In patients with AF and a prior CVA, patients undergoing ablation have lower rates of recurrent stroke compared to AF patients not ablated. Although the full mechanisms of benefit are unknown, as CVA rates are similar to patients without AF these data are suggestive of a potential altering of the natural history of disease progression.<br /> (© 2017 Wiley Periodicals, Inc.)
- Subjects :
- Action Potentials
Aged
Aged, 80 and over
Anti-Arrhythmia Agents therapeutic use
Anticoagulants therapeutic use
Atrial Fibrillation diagnosis
Atrial Fibrillation mortality
Atrial Fibrillation physiopathology
Case-Control Studies
Databases, Factual
Female
Heart Failure etiology
Heart Failure physiopathology
Heart Rate
Humans
Male
Middle Aged
Recurrence
Risk Assessment
Risk Factors
Stroke diagnosis
Stroke mortality
Stroke physiopathology
Time Factors
Treatment Outcome
Atrial Fibrillation surgery
Catheter Ablation adverse effects
Stroke prevention & control
Subjects
Details
- Language :
- English
- ISSN :
- 1540-8167
- Volume :
- 29
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Journal of cardiovascular electrophysiology
- Publication Type :
- Academic Journal
- Accession number :
- 29131434
- Full Text :
- https://doi.org/10.1111/jce.13390