Ablation for AF Reduces Mortality and Stroke

A new study suggests that catheter-based ablation lowers the risk of mortality, ischemic stroke, and hemorrhagic stroke in patients with atrial fibrillation (AF).

Researchers at the University of California Davis (UCD; USA) conducted a study to compare stroke and mortality in 4,169 AF patients who underwent ablation and 4,169 matched controls, selected by years of AF diagnosis, age, sex, and being alive the same number of days from the initial AF encounter to the ablation date. Those with valve disease, open maze, other arrhythmias, or implantable devices were excluded. Mortality and ischemic or hemorrhagic stroke were assessed, with adjustment for demographics, prior admissions with AF before the ablation, calendar year, and presence of chronic comorbidities.

The results revealed that while outcomes within 30 days of hospitalization were similar for both groups, long-term benefits of ablation became apparent after 3.6 years or more of follow-up. At that time, 84 patients died in the ablation group, compared to 189 in the control group; 55 patients in the ablation group suffered ischemic stroke, versus 86 in the control group; and 17 patients in the ablation group had hemorrhagic strokes, compared to 53 in the control group. The study was published on June 8, 2018, in Circulation: Arrhythmia and Electrophysiology.

“Ablation is currently only recommended when AF medications don't work, or aren't well tolerated. Less than two percent of patients undergo ablation early in the course of AF, when the procedure can be most beneficial,” said lead author professor of cardiovascular medicine Uma Srivatsa, MD. “Our data supports wider utilization of ablation along with improving the awareness of its benefits. Ablation may be considered as a primary treatment for everyone with the condition.”

Cardiac catheter ablation procedures are used to treat a variety of cardiac arrhythmias, especially supraventricular tachyarrhythmias such as AF, atrial flutter, and atrial tachycardia. The procedures involve advancing a catheter into the heart and selectively ablating certain areas of tissue in order to prevent the spread of electrical signals that give rise to the arrhythmia. The procedure is low-risk and usually takes 2-4 hours. It is most often performed in an electrophysiology or a cardiac catheterization lab. It is successful in about 90% of the people who have it.

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