Catheter ablation for paroxysmal atrial fibrillation was associated with lower 5-year ischaemic stroke rates compared to non-ablation (HR 0.823; 95% CI 0.785-0.863; P<0.0001).
Observational (n=51,182)
Yes
Does catheter ablation reduce ischaemic stroke rates and all-cause mortality in adults with paroxysmal atrial fibrillation?
In a large real-world cohort of patients with paroxysmal atrial fibrillation, catheter ablation was associated with significantly lower 5-year rates of ischaemic stroke and all-cause mortality compared to a propensity-matched non-ablation group.
Effect estimate: HR 0.823 (95% CI 0.785-0.863)
Absolute Event Rate: 7.96% vs 9.52%
p-value: p=< 0.0001
AIMS: Atrial fibrillation (AF) poses significant risks of stroke and mortality. Catheter ablation (CA) has emerged as a superior rhythm control strategy compared with medical therapy, but its long-term benefits in AF, in ischaemic stroke prevention, remain underexplored. METHODS AND RESULTS: This observational study analysed data from the TriNetX Research Network, encompassing over 115 million patients. Adults diagnosed with paroxysmal atrial fibrillation (PAF) between 2012 and 2019 were stratified into CA and non-CA groups. Propensity score matching (PSM) accounted for baseline differences in demographics, comorbidities, and medication use. The primary outcome was ischaemic stroke rates at five years, with and without prior ischaemic stroke. Secondary outcomes included all-cause mortality. Kaplan-Meier survival analysis and Cox proportional hazards regression were used to estimate adjusted hazard ratios (HRs). Among 791 013 patients with PAF, 53 178 (6.7%) underwent CA. Post-PSM, ischaemic stroke rates were significantly lower in the CA group (7.96% vs. 9.52%, HR: 0.823, 95% confidence interval, CI: 0.785-0.863, P < 0.0001), even after excluding patients with prior ischaemic stroke (de novo ischaemic stroke) (4.70% vs. 6.43% HR: 0.709, 95% CI: 0.665-0.756, P < 0.0001). All-cause mortality was markedly reduced (9.33% vs. 20.68% HR: 0.388, 95% CI: 0.373-0.404, P < 0.0001). CONCLUSION: This large-scale study demonstrates that in PAF patients CA is associated with lower ischaemic stroke rates and all-cause mortality compared with a PSM group without CA. These findings support urgent evaluation of CA in managing PAF and highlight its role in potentially improving survival and reducing stroke risk. Further trials are needed to support these findings.
Maraey et al. (Sat,) conducted a observational in paroxysmal atrial fibrillation (PAF) (n=51,182). Catheter ablation vs. Non-catheter ablation (medical therapy) was evaluated on ischaemic stroke rates at five years (HR 0.823, 95% CI 0.785-0.863, p=< 0.0001). Catheter ablation for paroxysmal atrial fibrillation was associated with lower 5-year ischaemic stroke rates compared to non-ablation (HR 0.823; 95% CI 0.785-0.863; P<0.0001).