Catheter ablation vs antiarrhythmic drug therapy for first-line treatment of atrial fibrillation in United States clinical practice.

BACKGROUND: Catheter ablation (CA) has a Class I indication for first-line rhythm control for atrial fibrillation (AF). OBJECTIVE: This study aimed to compare the safety and effectiveness of CA vs antiarrhythmic drug (AAD) for first-line rhythm control therapy in clinical practice. METHODS: Persons with incident AF (2015-2022) in the Optum Clinformatics cohort were categorized by the first-line treatment they received (CA or AAD). The incidence of hospitalization for atrial arrhythmia (AF, atrial flutter, or tachycardia) at 1-year (3-month blanking period) was compared between CA and AAD. Cox regression with inverse probability of treatment weighting was used to compare outcomes between treatment groups. RESULTS: A total of 2711 CA-treated (mean age 66.4 ± 10.7 years, 39.8% woman) and 22,726 AAD-treated (mean age 70.3 ± 11.4 years, 52.2% woman) persons with a new diagnosis of AF were included. Patients undergoing CA as the first-line therapy had a 48% lower risk (adjusted hazard ratio [HR] = 0.52, 95% confidence interval [CI] 0.40-0.68) of hospitalization for atrial arrhythmia, a 52% lower risk of AF-related electrical cardioversion (HR = 0.48, 95% CI 0.34-0.68), and a 74% lower risk of hospitalization for heart failure (HR = 0.26, 95% CI 0.13-0.54) compared with those receiving first-line AAD therapy. Lower risks of atrial arrhythmia hospitalization were also found with first-line CA receipt vs AAD in paroxysmal (HR = 0.52, 95% CI 0.37-0.73) and persistent AF (HR = 0.55, 95% CI 0.37-0.81). CONCLUSION: First-line CA for both paroxysmal and persistent AF is associated with significantly lower risk of hospitalization for atrial arrhythmia consistent with results from randomized clinical trials and current Class I guideline recommendations.

Duke Scholars

Author Jonathan Paul Piccini Sr. Medicine, Cardiology