Association of pulmonary vein isolation and major cardiovascular events in patients with atrial fibrillation

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Atrial fibrillation (n=2518). Intervention: Pulmonary vein isolation (PVI) vs. Non-PVI. Primary outcome: All-cause mortality (HR 0.39, 95% CI 0.19-0.79, p=0.009).

Marc Girod; Michael Coslovsky; Stefanie Aeschbacher; Christian Sticherling; Tobias Reichlin; Laurent Roten; Nicolas Rodondi; Peter Ammann; Angelo Auricchio; Giorgio Moschovitis; Richard Kobza; Patrick Badertscher; Sven Knecht; Philipp Krisai; Andrea Marugg; Helena Aebersold; Elisa Hennings; Miquel Serra‐Burriel; Matthias Schwenkglenks; Christine S. Zuern; Leo H. Bonati; David Conen; Stefan Osswald; Michael Kühne

doi:10.1007/s00392-022-02015-0

Key result

PVI is linked to ~61% lower mortality and fewer acute heart failure admissions in AF.

HR 0.39
95% CI 0.19-0.79
P=0.009
n=2,518

Why the study?

Patients with AF face an increased risk of adverse cardiovascular events, and evidence suggests early rhythm control including AF ablation may reduce this risk.

Does pulmonary vein isolation reduce cardiovascular events and mortality in patients with atrial fibrillation?

Study Design

Type

Cohort (n=2,518)

Multicenter

Yes

Structured PICO

Does pulmonary vein isolation reduce cardiovascular events and mortality in patients with atrial fibrillation?

P

Population

2,518 matched patients with atrial fibrillation from two prospective cohort studies in Switzerland. Median age 66 years, 25.8% female.

I

Intervention

Pulmonary vein isolation (PVI) during a 1-year observational period

C

Comparator

Non-PVI (no pulmonary vein isolation), assigned using coarsened exact matching

O

Outcome

All-cause mortality, hospital admission for acute heart failure, a composite of stroke, transient ischemic attack and systemic embolism (Stroke/TIA/SE), myocardial infarction (MI), and bleedingshard clinical

Main Result

Effect estimate: HR 0.39 (95% CI 0.19-0.79)

Absolute Event Rate: 0.64% vs 1.87%

p-value: p=0.009

In a matched cohort of patients with atrial fibrillation, pulmonary vein isolation was associated with a significant reduction in all-cause mortality and hospital admissions for acute heart failure over a median 3.9 years of follow-up.

Limitations

Unaccounted confounders likely persist, meaning causality cannot be established
Potential survival bias by excluding patients who did not survive to the first follow-up visit
Low statistical power to detect differences in rare outcomes such as stroke or acute coronary syndrome
Rhythm outcome information was not systematically available for all patients

Implication

PVI-associated mortality reduction in AF should not yet change practice; leaves open whether RCTs will confirm benefit.

Abstract

BACKGROUND: Patients with atrial fibrillation (AF) face an increased risk of adverse cardiovascular events. Evidence suggests that early rhythm control including AF ablation may reduce this risk. METHODS: To compare the risks for cardiovascular events in AF patients with and without pulmonary vein isolation (PVI), we analysed data from two prospective cohort studies in Switzerland (n = 3968). A total of 325 patients who had undergone PVI during a 1-year observational period were assigned to the PVI group. Using coarsened exact matching, 2193 patients were assigned to the non-PVI group. Outcomes were all-cause mortality, hospital admission for acute heart failure, a composite of stroke, transient ischemic attack and systemic embolism (Stroke/TIA/SE), myocardial infarction (MI), and bleedings. We calculated multivariable adjusted Cox proportional-hazards models. RESULTS: Overall, 2518 patients were included, median age was 66 years [IQR 61.0, 71.0], 25.8% were female. After a median follow-up time of 3.9 years, fewer patients in the PVI group died from any cause (incidence per 100 patient-years 0.64 versus 1.87, HR 0.39, 95%CI 0.19-0.79, p = 0.009) or were admitted to hospital for acute heart failure (incidence per 100 patient-years 0.52 versus 1.72, HR 0.44, 95%CI 0.21-0.95, p = 0.035). There was no significant association between PVI and Stroke/TIA/SE (HR 0.94, 95%CI 0.52-1.69, p = 0.80), MI (HR 0.43, 95%CI 0.11-1.63, p = 0.20) or bleeding (HR 0.75, 95% CI 0.50-1.12, p = 0.20). CONCLUSIONS: In our matched comparison, patients in the PVI group had a lower incidence rate of all-cause mortality and hospital admission for acute heart failure compared to the non-PVI group. GOV IDENTIFIER: NCT02105844, April 7th 2014.

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Figures from the paper

Published by Clinical Research in Cardiology · CC BY

Cite This Study

Girod et al. (2022) conducted a cohort in Atrial fibrillation (n=2,518). Pulmonary vein isolation (PVI) vs. Non-PVI was evaluated on All-cause mortality (HR 0.39, 95% CI 0.19-0.79, p=0.009). Pulmonary vein isolation significantly reduced all-cause mortality (HR 0.39) and hospital admissions for acute heart failure compared to no isolation in patients with atrial fibrillation.

synapsesocial.com/papers/6a110de96f378c85fcf33f1f https://doi.org/10.1007/s00392-022-02015-0