Catheter ablation of atrial fibrillation is associated with reduced mortality in real-world swedish patients

FUNDING ACKNOWLEDGEMENTS: Type of funding sources: Foundation. Main funding source(s): Swedish heart-lung foundation Swedish research council BACKGROUND: Catheter ablation of atrial fibrillation (AF) is effective in reducing symptomatic burden, however its long-term effect on stroke and mortality is still unclear. PURPOSE: The aim of this study is to evaluate if catheter ablation reduces the risk for stroke and all-cause mortality risk in patients with AF in a large real-world Swedish cohort. METHODS: We retrospectively included 5,629 consecutive patients (cases) who underwent first-time catheter ablation for AF between 2008 and 2018 at three major Swedish electrophysiology sites. For every case, 10 control individuals with a diagnosis of AF and no prior stroke or catheter ablation were selected based on age and sex from the Swedish Patient Register, resulting in a control group of 48,682 patients. Propensity score (PS) matching was performed to produce two cohorts of equal size (n = 3,955) with similar demographics, comorbidities, health care utilization and medical therapy prior to inclusion (45 dimensions with non-significant standardized differences between the two cohorts). Cancer diagnosis was used as a falsification end-point to estimate similarity of the cohorts (hazard ratio [HR] 1.06, 95% confidence interval [CI] 0.92-1.23). RESULTS: Prior to PS-matching, patients who underwent catheter ablation were healthier (mean CHA2DS2-VASc scores 1.4±1.3 vs 1.7±1.5, p<0.001), more likely to be on antiarrhythmic drug therapy (58% vs 10%, p<0.001), had a higher median income (288 [193-420] vs 211 [144-306], p<0.001) and had more frequently university studies (45% vs 29%, p<0.001), when compared to the control group. Mean follow-up was 4.5±2.8 years. Following PS-matching, the mean age was 61±10 years, 70% were males and 47% had hypertension. Catheter ablation was associated with a lower risk for the combined primary end-point of stroke and all-cause mortality (HR 0.57, 95% CI 0.48-0.69) which occurred in 174 patients in the ablated group compared to 292 in the control group (figure). The primary end-point was driven by all-cause mortality (HR 0.51, 95% CI 0.41-0.63) with stroke reduction showing a trend in favor of catheter ablation (HR 0.75, 95% CI 0.53-1.07) (table). CONCLUSIONS: Catheter ablation of AF may reduce the risk for all-cause mortality when compared to medical therapy in real-world Swedish patients. [Figure: see text] [Figure: see text]