Catheter ablation for atrial fibrillation: who, why and does it work?

Eyre-Brook, S N; Rajappan, Kim

doi:10.1136/postgradmedj-2012-130896

Cited by 4 publications

(3 citation statements)

References 44 publications

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“…Multiple studies have also highlighted that maintaining sinus rhythm was the most important factor in predicting stroke-free survival and lower mortality [ 15 - 17 ]. Furthermore, besides the current consensus of preserving catheter ablation for symptomatic patients with drug-refractory atrial fibrillation [ 18 ], there is sufficient evidence that catheter ablation for patients with paroxysmal AF is highly effective in curtailing progression to persistent AF [ 19 ] and achieves better results of sinus rhythm maintenance [ 20 ]. Observational studies showing a mortality benefit with catheter ablation are summarized in Table 2 .…”

Section: Reviewmentioning

confidence: 99%

Does Catheter Ablation Lower the Long-Term Risk of Stroke and Mortality in Patients with Atrial Fibrillation? A Concise Review of the Current State of Knowledge

Ryad

Saad-Omer

Khan

et al. 2020

Cureus

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Atrial fibrillation (AF) is the most common cardiac arrhythmia worldwide and carries a significant risk of morbidity and mortality. Multiple trials have highlighted the benefit of catheter ablation over medical therapy in restoring sinus rhythm and improving quality of life. Whether it reduces long-term risk of stroke and mortality is still unclear. We performed a literature search using the PubMed database to review the current state of knowledge regarding the long-term outcomes of stroke and mortality in ablated patients compared to patients who receive medical therapy. Our review mainly consisted of recent randomized controlled trials and large observational studies. Results from large observational studies show that catheter ablation significantly reduces the risk of stroke in high-risk patients and mortality compared to medical therapy. However, randomized controlled trials have only demonstrated a mortality benefit in patients with comorbid systolic heart failure. In patients with paroxysmal AF, ablation therapy significantly limits the progression to persistent AF and has a higher efficacy in restoring sinus rhythm. Maintenance of sinus rhythm is the most important factor associated with lower long term risk of stroke and mortality. Large randomized controlled trials similar to the Catheter Ablation Versus Anti-arrhythmic Drug Therapy for Atrial Fibrillation (CABANA) trial are still needed to clarify whether catheter ablation is superior over medical therapy in improving the long-term outcomes of stroke and mortality.

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Section: Reviewmentioning

confidence: 99%

Does Catheter Ablation Lower the Long-Term Risk of Stroke and Mortality in Patients with Atrial Fibrillation? A Concise Review of the Current State of Knowledge

Ryad

Saad-Omer

Khan

et al. 2020

Cureus

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“…1,2 RF ablation of AF is more effective than anti-arrhythmic drugs at restoring sinus rhythm and may improve mortality, morbidity and quality of life in patients with symptomatic AF. 3,4 AF is the most common cardiac arrhythmia. 4 Several studies have shown that visualisation could be a suitable adjunct to the usual analgesics used during medical invasive procedures, and effectively reduce the patient's perception of pain intensity and anxiety during the procedures.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Visualisation during ablation of atrial fibrillation – stimulating the patient’s own resources: Patients’ experiences in relation to pain and anxiety during an intervention of visualisation

Nørgaard

Pedersen

Bjerrum

2014

European Journal of Cardiovascular Nursing

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Visualisation used during ablation of atrial fibrillation was reported as a positive experience with no serious inconvenience: It seemed that visualisation did not produce complete analgesia but the patients expressed that it provided some pain relief and supported their individual strategies in managing pain and anxiety. Our findings indicate that visualisation for acute pain during ablation of atrial fibrillation was associated not only with a decrease in experience of pain but also with high levels of treatment satisfaction and other non-pain-related benefits.

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Effect of Radiofrequency Catheter Ablation for Atrial Fibrillation on Morbidity and Mortality

Chang

Lin

Chiu

et al. 2014

Circ: Arrhythmia and Electrophysiology

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Background— This study examined the effect of radiofrequency catheter ablation (RFA) on reducing morbidity and mortality among patients with atrial fibrillation (AF). Methods and Results— A retrospective cohort of patients with AF without prior stroke or heart failure (HF) who underwent RFA between 2003 and 2009 was identified using Taiwan’s National Health Insurance claims database. Outpatients with AF who met the same enrollment criteria but did not receive RFA were matched (≤1:20) by hospitals and dates to serve as controls. Outcomes of interest were death, stroke, or hospitalization for HF. A proportional hazard Cox regression model adjusted by propensity scores (based on age, sex, hypertension, diabetes mellitus, comorbidities, medications, and medical resource utilization) was applied to estimate the hazard ratio and 95% confidence interval. A total of 846 patients with AF who received RFA and 11 324 matched AF controls were included, with a mean follow-up of 3.74 and 3.96 years, respectively. RFA was associated with a lower hazard for stroke (hazard ratio, 0.57; 95% confidence interval, 0.35–0.94; P =0.026). The reduction in the hazard for death and HF did not reach statistical significance (hazard ratio, 0.88; 95% confidence interval, 0.62–1.23; P =0.451 and hazard ratio, 0.78; 95% confidence interval, 0.55–1.12; P =0.185, respectively). Additional analysis using death as a competing risk showed similar results for stroke and HF. Conclusions— RFA did not reduce mortality or hospitalization for HF during the immediate 3.5-year follow-up. Although a beneficial effect on stroke prevention associated with RFA was suggested, residual confounding attributable to unmeasured factors remains a concern.

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Catheter ablation for atrial fibrillation: who, why and does it work?

Cited by 4 publications

References 44 publications

Does Catheter Ablation Lower the Long-Term Risk of Stroke and Mortality in Patients with Atrial Fibrillation? A Concise Review of the Current State of Knowledge

Does Catheter Ablation Lower the Long-Term Risk of Stroke and Mortality in Patients with Atrial Fibrillation? A Concise Review of the Current State of Knowledge

Visualisation during ablation of atrial fibrillation – stimulating the patient’s own resources: Patients’ experiences in relation to pain and anxiety during an intervention of visualisation

Effect of Radiofrequency Catheter Ablation for Atrial Fibrillation on Morbidity and Mortality

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