Longitudinal risk of death, hospitalizations for atrial fibrillation, and cardiovascular events following catheter ablation of atrial fibrillation: a cohort study

Abstract

Background Population studies reporting contemporary long-term outcomes following catheter ablation of atrial fibrillation (AF) are sparse. Objective To evaluate long-term clinical outcomes following AF ablation and examine variation in outcomes by age, sex, and the presence of heart failure. Methods and Results We identified 30,601 unique patients (mean age 62.7±11.8y, 30.0% female) undergoing AF ablation from 2008-17 in Australia and New Zealand using nation-wide hospitalisation data. The primary outcomes were all-cause mortality; and re-hospitalisations for AF or flutter, repeat AF ablation, and cardioversion. Secondary outcomes were re-hospitalisations for other cardiovascular events. During 124,858.7 person-years of follow-up, 1,900 patients died (incident rate 1.5/100 person-years) with a survival probability of 93.0% (95%CI 92.6%-93.4%) by 5 years and 84.0% (95%CI 82.4%-85.5%) by 10 years. Re-hospitalisations for AF or flutter (13.3/100 person-years), repeat ablation (5.9/100 person-years), and cardioversion (4.5/100 person-years) were common with respective cumulative incidence of 49.4% (95%CI 48.4%-50.4%), 28.1% (95%CI 27.2%-29.0%), and 24.4% (95%CI 21.5%-27.5%) at 10-years post-ablation. Re-hospitalisations for stroke (0.7/100 person-years), heart failure (1.1/100 person-years), acute myocardial infarction (0.4/100 person-years), syncope (0.6/100 person-years), other arrhythmias (2.5/100 person-years), and new cardiac device implantation (2.0/100 person-years) occurred less frequently. Elderly patients and those with comorbid heart failure had worse survival but were less likely to undergo repeat ablation, while long-term outcomes were comparable between sex. Conclusion Patients undergoing AF ablations had good long-term survival, a low incidence of re-hospitalisations for stroke or heart failure, and about half remained free of re-hospitalisations for AF or flutter, including for repeat AF ablation, or cardioversion.

Novel Pulmonary Delivery of Drugs for the Management of Atrial Fibrillation

“…Nevertheless, ablation is invasive and is associated with a clinically significant risk of early complications [16]. Moreover, about half of patients undergoing AF ablation have recurrence of AF of sufficient severity to warrant rehospitalization over time; thus, this is not a cure or replacement for pharmacological therapy [17]. Furthermore, anticoagulation reduces but does not eliminate the embolic risk of AF [6] and is associated with a risk of bleeding [18].…”

The correlation between gut microbiome and atrial fibrillation: pathophysiology and therapeutic perspectives

“…Atrial fibrillation (AF) is the terminal ordinary endpoint of atrial remodeling attributable to multiple cardiac diseases and is a prominent contributor to cardiovascular morbidity and mortality [ 7 ]. Although the development of AF ablation techniques has created more alternatives for AF treatment, investigations have highlighted that nearly 50% of patients still demand repeat ablation [ 8 ]. Nowadays, the pathogenesis of AF has not been thoroughly elaborated, so it is pivotal to explore the underlying mechanism to prevent and manage it.…”