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

Abstract

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.

Catheter Ablation for Atrial Fibrillation in Patients with Chronic Kidney Disease and on Dialysis: A Meta-Analysis and Review

“…In the general population, catheter ablation has been shown to be equal to anti-arrhythmic drug therapy in reducing rates of mortality, disabling strokes, serious bleeding, and cardiac arrest in a randomized control trial [16]. This is contrary to results from observational studies showing catheter ablation to be superior in reducing strokes and mortality [17]. Recently, a cohort study showed AF catheter ablation significantly reduces the risk of both ischaemic strokes and intracranial haemorrhages compared to medical therapy, regardless of whether sinus rhythm was maintained [18].…”

Impact of transseptal puncture location on the fossa ovalis on first-pass pulmonary vein isolation

“…In particular, as its higher success rate than that of antiarrhythmic drug therapy, catheter ablation has emerged as a first-line therapy over the past 10 years. 2 Actually, catheter ablation has been shown to reduces stroke, 3,4 heart failure, and all-cause mortality. 5 6 Regarding the source of AF, the pulmonary vein (PV) has been identified as the most common trigger site for AF.…”