Health Outcomes With Catheter Ablation or Antiarrhythmic Drug Therapy in Atrial Fibrillation

BACKGROUND: Patients with atrial fibrillation (AF) face significant risks of stroke and heart failure. The objective of this study was to determine whether AF ablation reduces the long-term risk of stroke or heart failure compared with antiarrhythmic drug therapy. METHODS AND RESULTS: A coding algorithm was used to identify AF patients treated with catheter ablation (n=3194) or antiarrhythmic drugs without ablation (n=6028) between 2005 and 2009 using The MarketScan Research Database from Thomson Reuters From this sample, 801 pairs were propensity matched, based on 15 demographic and clinical characteristics and baseline medication use. Rates of stroke/transient ischemic attack (TIA) and heart failure hospitalizations for up to 3 years were examined. Patients treated with catheter ablation had a significantly lower rate of stroke or TIA (3.4% per year) than a group of patients with AF managed with antiarrhythmic drugs only (5.5% per year), with an unadjusted hazard ratio of 0.62 (95% CI, 0.44-0.86; P=0.005). The rates for heart failure hospitalization were 1.5% per year in the ablation group and 2.2% per year in the antiarrhythmic drug group, with an unadjusted hazard ratio of 0.69 (95% CI, 0.42-1.15; P=0.158). These results were minimally altered in Cox proportional hazards models, which further adjusted for potential confounders not well balanced by the propensity matching. CONCLUSIONS: In a large propensity-matched community sample, AF ablation was associated with a reduced risk of stroke/TIA and no significant difference in heart failure hospitalizations compared with antiarrhythmic drug therapy. These findings require confirmation with randomized study designs.