Comparison of Long-Term Adverse Outcomes in Patients With Atrial Fibrillation Having Ablation Versus Antiarrhythmic Medications.
Journal
The American journal of cardiology
ISSN: 1879-1913
Titre abrégé: Am J Cardiol
Pays: United States
ID NLM: 0207277
Informations de publication
Date de publication:
15 02 2020
15 02 2020
Historique:
received:
19
07
2019
revised:
07
11
2019
accepted:
08
11
2019
pubmed:
18
12
2019
medline:
25
6
2020
entrez:
18
12
2019
Statut:
ppublish
Résumé
The impact of atrial fibrillation (AF) catheter ablation versus chronic antiarrhythmic therapy alone on clinical outcomes such as death and stroke remains unclear. We compared adverse outcomes for AF ablation versus chronic antiarrhythmic therapy in 1,070 adults with AF treated between 2010 and 2014 in the Kaiser Permanente Northern California and Southern California healthcare delivery systems. Patients who underwent AF catheter ablation were matched to patients treated with only antiarrhythmic medications, based on age, gender, history of heart failure, history of coronary heart disease, history of hypertension, history of diabetes, and high-dimensional propensity score. We compared crude and adjusted rates of death, ischemic stroke or transient ischemic attack, intracranial hemorrhage, and hospitalization. The matched cohort of 535 patients treated with AF ablation and 535 treated with antiarrhythmic therapy had a median follow-up of 2.0 (interquartile range 1.1 to 3.5) years. There was no significant difference in adjusted rates of death (adjusted hazard ratio [HR] 0.24, 95% confidence interval [CI] 0.03 to 1.95), intracranial hemorrhage (adjusted HR 0.17, CI 0.02 to 1.71), ischemic stroke or transient ischemic attack (adjusted HR 0.53, CI 0.18 to 1.60), and heart failure hospitalization (adjusted HR 0.85, CI 0.34 to 2.12), although there was a trend toward improvement in these outcomes with ablation. However, there was a significantly increased risk of all-cause hospitalization following ablation (adjusted HR 1.60, CI 1.25 to 2.05). In a contemporary, multicenter, propensity-matched observational cohort, AF ablation was not significantly associated with death, intracranial hemorrhage, ischemic stroke or transient ischemic attack, or heart failure hospitalization, but was associated with a higher rate of all cause-hospitalization.
Identifiants
pubmed: 31843233
pii: S0002-9149(19)31296-2
doi: 10.1016/j.amjcard.2019.11.004
pmc: PMC6987016
mid: NIHMS1546653
pii:
doi:
Substances chimiques
Anti-Arrhythmia Agents
0
Types de publication
Comparative Study
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
553-561Subventions
Organisme : NHLBI NIH HHS
ID : K23 HL118147
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR001863
Pays : United States
Informations de copyright
Copyright © 2019 Elsevier Inc. All rights reserved.
Références
N Engl J Med. 2004 Sep 23;351(13):1296-305
pubmed: 15385656
Circ Arrhythm Electrophysiol. 2018 Jun;11(6):e005739
pubmed: 29884619
Heart Rhythm. 2013 Sep;10(9):1272-7
pubmed: 23835257
J Am Med Inform Assoc. 1997 May-Jun;4(3):233-7
pubmed: 9147342
Ann Intern Med. 2006 Aug 15;145(4):247-54
pubmed: 16908915
Circulation. 2006 Jun 13;113(23):2713-23
pubmed: 16754803
Circ Cardiovasc Qual Outcomes. 2010 Nov;3(6):615-23
pubmed: 20940250
J Natl Cancer Inst. 2000 Jan 19;92(2):136-42
pubmed: 10639515
JAMA. 2001 May 16;285(19):2486-97
pubmed: 11368702
J Geriatr Cardiol. 2015 Sep;12(5):507-14
pubmed: 26512242
Circ Cardiovasc Qual Outcomes. 2008 Nov;1(2):138-47
pubmed: 20031802
J Cardiovasc Electrophysiol. 2011 Aug;22(8):839-45
pubmed: 21410581
Heart Rhythm. 2007 Jun;4(6):816-61
pubmed: 17556213
Arch Intern Med. 2008 Dec 8;168(22):2415-21
pubmed: 19064823
Circulation. 2009 Sep 22;120(12):1036-40
pubmed: 19738139
Eur Heart J. 2016 Aug;37(31):2478-87
pubmed: 26984861
J Am Heart Assoc. 2015 May 21;4(5):
pubmed: 25999401
Diabetes Care. 1997 Sep;20(9):1396-402
pubmed: 9283786
Perm J. 2012 Summer;16(3):37-41
pubmed: 23012597
Open Heart. 2015 Sep 10;2(1):e000302
pubmed: 26380100
Ann Intern Med. 2009 May 5;150(9):604-12
pubmed: 19414839
Epidemiology. 2009 Jul;20(4):512-22
pubmed: 19487948
Circulation. 2014 Dec 2;130(23):e199-267
pubmed: 24682347
J Am Coll Cardiol. 2010 May 25;55(21):2308-16
pubmed: 20488300
Am J Public Health. 1984 Dec;74(12):1324-30
pubmed: 6507683
Circulation. 2016 Apr 26;133(17):1637-44
pubmed: 27029350
N Engl J Med. 2018 Feb 01;378(5):417-427
pubmed: 29385358
Am J Kidney Dis. 2002 Feb;39(2 Suppl 1):S1-266
pubmed: 11904577
JAMA. 2019 Apr 2;321(13):1261-1274
pubmed: 30874766
Am J Cardiol. 2018 Mar 1;121(5):602-608
pubmed: 29331355