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Outcomes and Anticoagulation Use After Catheter Ablation for Atrial Fibrillation.

Publication ,  Journal Article
Freeman, JV; Shrader, P; Pieper, KS; Allen, LA; Chan, PS; Fonarow, GC; Gersh, BJ; Kowey, PR; Mahaffey, KW; Naccarelli, G; Reiffel, JA; Go, AS ...
Published in: Circ Arrhythm Electrophysiol
December 2019

BACKGROUND: Studies evaluating the effects of atrial fibrillation (AF) catheter ablation versus antiarrhythmic therapy on outcomes have shown mixed results. In addition, guidelines recommend continuing oral anticoagulation (OAC) after ablation for those at risk of stroke, but real-world data are lacking. METHODS: We evaluated outcomes including death, myocardial infarction, stroke or systemic embolism, intracranial bleeding, major bleeding, and hospitalization in patients undergoing AF ablation compared with a propensity score matched cohort of patients treated with anti-arrhythmic medications only in the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation registries. Cox proportional hazards regression was performed to evaluate the association between AF ablation and outcomes. We then evaluated patterns of treatment with OAC among AF ablation patients. RESULTS: Among 21 595 patients, 1190 (6%) underwent de novo AF ablation. Our propensity score-matched cohort included 1087 patients who underwent AF ablation matched 1:1 with 1087 patients treated with antiarrhythmic medications only. There were no significant differences in the risk of all-cause and cardiovascular death, and most other major adverse cardiovascular and neurological events. AF catheter ablation was associated with an increased risk of all-cause hospitalization during follow-up (hazard ratio, 1.24 [95% CI, 1.05-1.46]), particularly in the first 3 months (the standard blanking period) after the procedure. Among those who underwent AF ablation with a CHA2DS2 VASc score ≥2 for men and ≥3 for women, 23% had OAC discontinued after ablation. Among those who discontinued OAC, the median time to discontinuation was 6.2 months. CONCLUSIONS: In this large US national registry, we found no difference in adjusted rates of cardiovascular or all-cause death between patients treated with AF catheter ablation and antiarrhythmic medications only. Notably, discontinuation of OAC after ablation remains relatively common despite guideline recommendations for continued stroke prevention therapy in patients at risk of stroke.

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Published In

Circ Arrhythm Electrophysiol

DOI

EISSN

1941-3084

Publication Date

December 2019

Volume

12

Issue

12

Start / End Page

e007612

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Time Factors
  • Stroke
  • Risk Factors
  • Risk Assessment
  • Registries
  • Myocardial Infarction
  • Middle Aged
  • Male
 

Citation

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MLA
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Freeman, J. V., Shrader, P., Pieper, K. S., Allen, L. A., Chan, P. S., Fonarow, G. C., … Piccini, J. P. (2019). Outcomes and Anticoagulation Use After Catheter Ablation for Atrial Fibrillation. Circ Arrhythm Electrophysiol, 12(12), e007612. https://doi.org/10.1161/CIRCEP.119.007612
Freeman, James V., Peter Shrader, Karen S. Pieper, Larry A. Allen, Paul S. Chan, Gregg C. Fonarow, Bernard J. Gersh, et al. “Outcomes and Anticoagulation Use After Catheter Ablation for Atrial Fibrillation.Circ Arrhythm Electrophysiol 12, no. 12 (December 2019): e007612. https://doi.org/10.1161/CIRCEP.119.007612.
Freeman JV, Shrader P, Pieper KS, Allen LA, Chan PS, Fonarow GC, et al. Outcomes and Anticoagulation Use After Catheter Ablation for Atrial Fibrillation. Circ Arrhythm Electrophysiol. 2019 Dec;12(12):e007612.
Freeman, James V., et al. “Outcomes and Anticoagulation Use After Catheter Ablation for Atrial Fibrillation.Circ Arrhythm Electrophysiol, vol. 12, no. 12, Dec. 2019, p. e007612. Pubmed, doi:10.1161/CIRCEP.119.007612.
Freeman JV, Shrader P, Pieper KS, Allen LA, Chan PS, Fonarow GC, Gersh BJ, Kowey PR, Mahaffey KW, Naccarelli G, Reiffel JA, Singer DE, Go AS, Hylek EM, Steinberg BA, Peterson ED, Piccini JP. Outcomes and Anticoagulation Use After Catheter Ablation for Atrial Fibrillation. Circ Arrhythm Electrophysiol. 2019 Dec;12(12):e007612.

Published In

Circ Arrhythm Electrophysiol

DOI

EISSN

1941-3084

Publication Date

December 2019

Volume

12

Issue

12

Start / End Page

e007612

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Time Factors
  • Stroke
  • Risk Factors
  • Risk Assessment
  • Registries
  • Myocardial Infarction
  • Middle Aged
  • Male