TY - JOUR
T1 - Outcomes and Anticoagulation Use After Catheter Ablation for Atrial Fibrillation
AU - Freeman, James V.
AU - Shrader, Peter
AU - Pieper, Karen S.
AU - Allen, Larry A.
AU - Chan, Paul S.
AU - Fonarow, Gregg C.
AU - Gersh, Bernard J.
AU - Kowey, Peter R.
AU - Mahaffey, Kenneth W.
AU - Naccarelli, Gerald
AU - Reiffel, James A.
AU - Singer, Daniel E.
AU - Go, Alan S.
AU - Hylek, Elaine M.
AU - Steinberg, Benjamin A.
AU - Peterson, Eric D.
AU - Piccini, Jonathan P.
N1 - Funding Information:
Dr Freeman is modest consulting/advisory board for Janssen, Medtronic, Bio-sense Webster, Boston Scientific. Research grant/salary support from the National Institutes of Health (NIH)/ National Heart, Lung, and Blood Institute (NHLBI) and the American College of Cardiology. Dr Allen reports consulting for ACI Clinical, Amgen/Cytokinetics, Boston Scientific, and Janssen; grant support from the American Heart Association, NIH, and Patient-Centered Outcomes Research Institute/Bristol-Myers Squibb. Dr Fonarow reports consulting for Abbott, Amgen, Bayer, Janssen, Medtronic, Novartis. B.J. Gersh is member of a Data Safety Monitoring Board for Mount Sinai St Lukes, Boston Scientific Corporation, Teva Pharmaceutical Industries, St Jude Medical, Janssen Research & Development, Baxter Healthcare Corporation, and Cardiovascular Research Foundation. Consultant/Advisory Board for Janssen Scientific Affairs, Cipla Limited, Armetheon Inc, and Medtronic. Dr Kowey reports Steering committee for CABANA (Catheter Ablation versus Antiarrhythmic Drug Therapy in Atrial Fibrillation) trial and consulting for Johnson & Johnson. Dr Mahaffey receives financial disclosures can be viewed at https://med.stanford.edu/profiles/ kenneth-mahaffey?tab=research-and-scholarship. Dr Naccarelli is consultant to Janssen, Glaxo Smith Kline, Sanofi, Novartis, Portola, Aceion and Omeicos. Research grant from Janssen. Dr Reiffel serves during the last 3 years; Dr Reiffel has been an investigator and consultant for Medtronic, Janssen, Gilead, and Sanofi; a consultant for Portola, Acesion, InCardia Therapeutics; and a member of speaker’s bureaus for Janssen and Boehringer Ingelheim. Dr Singer is consulting/advisory board for Boehringer Ingelheim, Johnson & Johnson, Merck, Pfizer, Bristol-Myers Squibb; Contracted research from Bristol-Myers Squibb and Boehringer Ingelheim. Dr Hylek is a member of the Consultant/Advisory Boards (modest) for Bayer, Boehringer-Ingelheim, Bristol-Myers-Squibb, Daiichi Sankyo, Janssen, Medtronic, Pfizer. Dr Kowey served as a Consultant/Advisory Board for Boehringer-Ingelheim, Bristol-Myers-Squibb, Johnson & Johnson, Portola, Merck, Sanofi, Daiichi Sankyo (all modest). Dr Steinberg supported by NIH grant K23HL143156, as well as research funded by the American Heart Association/Patient-Centered Outcomes Research Institute, Boston Scientific, Janssen, and the Population Health Research Institute; and consulting to Jans-sen, AltaThera, Merit Medical; and speaking for the North American Center for Continuing Medical Education/Sanofi. Dr Peterson receives research grant from Janssen Pharmaceuticals and Eli Lilly. Consultant for Janssen Pharmaceuticals and Boehringer Ingelheim. Dr Piccini receives research grant from Agency for Healthcare Research and Quality, ARCA biopharma, Boston Scientific, Gilead Sciences, Janssen Pharmaceuticals, Johnson & Johnson, ResMed, Spectranetics, and St Jude Medical. Consultant/Advisory Board for Bristol-Myers Squibb/Pfizer, GlaxoSmithKline, Janssen Pharmaceuticals, Johnson & Johnson, Medtronic, and Spectranetics. The other authors report no conflicts.
Publisher Copyright:
© 2019 Circulation: Arrhythmia and Electrophysiology. All rights reserved.
PY - 2019/12/1
Y1 - 2019/12/1
N2 - 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.
AB - 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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U2 - 10.1161/CIRCEP.119.007612
DO - 10.1161/CIRCEP.119.007612
M3 - Article
C2 - 31830822
AN - SCOPUS:85076488687
VL - 12
JO - Circulation: Arrhythmia and Electrophysiology
JF - Circulation: Arrhythmia and Electrophysiology
SN - 1941-3149
IS - 12
M1 - e007612
ER -