Impact of atrial fibrillation catheter ablation on mortality, stroke, and heart failure hospitalizations: A meta‐analysis

Abstract

Disclosures: Anselmino is consultant for Biosense Webster and has received lecture fees from Biosense Webster and Abbott; De Ponti has received lecture fees from Biosense Webster and Biotronik; Di Biase is a consultant for Stereotaxis Biosense Webster, Boston Scientific, and St Jude Medical and has received speaker honoraria/travel support from Medtronic, Atricure, EPiEP, and Biotronik. Other authors: No disclosure.Abstract Background: The impact of atrial fibrillation catheter ablation (AFCA) on hard clinical endpoints remains controversial. Objective: Our aim was to conduct a random-effect model meta-analysis on efficacy data from high-quality large matched database/registry studies and randomized clinical trials. We compared long-term all-cause mortality, stroke, and hospitalization for heart failure in patients undergoing AFCA vs patients treated with medical therapy alone (rhythm and/or rate control medications) in a general AF population. Methods and Results: PubMed/MEDLINE and Embase databases were screened and a total of nine studies were selected (one randomized clinical trial-CABANA-and eight large matched population studies). A total of 241 372 patients (27 711 in the ablation group, 213 661 in the nonablation group) were included. After a median follow-up of 3.5 years, AFCA decreased the risk of mortality (hazard ratio [HR], 0.62; 95% confidence interval [CI], 0.54-0.72; I 2 = 54%; number needed to treat[NNT] = 28), stroke (HR, 0.63; 95% CI, 0.56-0.70; I 2 = 23%; NNT = 59) and hospitalization for heart failure (HR, 0.64; 95% CI, 0.51-0.80; I 2 = 28%; NNT = 33) compared with AF patients treated with medical therapy alone.Conclusion: Based on the currently available efficacy and effectiveness evidence, AFCA significantly reduces the risk of death, stroke, and hospitalization compared with medical therapy alone. K E Y W O R D Sall-cause mortality, stroke, hard clinical outcomes, atrial fibrillation, catheter ablation

Long‐term outcomes of catheter ablation for atrial fibrillation: It's a matter of time

“…Pooled effect estimates were primarily driven by the observational studies (weight of CABANA estimates between 0.7% and 10.7%). The degree of heterogeneity between pooled studies was low for stroke ( I 2 = 23%) and HF hospitalizations ( I 2 = 28%), however, there was substantial heterogeneity among estimates for all‐cause mortality ( I 2 = 54%) 3 . The magnitude of heterogeneity ( I 2 = 29%) and hazards for all‐cause mortality (HR, 0.60 [95% CI, 0.53‐0.67]) with AF ablation decreased when the treatment‐received (HR, 0.60 [95% CI, 0.42‐0.86]) rather than intent‐to‐treat (HR, 0.85 [95% CI, 0.60‐1.21]) estimates for CABANA 5 were included in the random effects model reflecting that the treatment‐received analysis more closely mimics the real‐world observational estimates.…”

“…Several randomized trials have demonstrated that AF ablation reduces AF recurrences and improves quality of life when compared with AADs 2 . The efficacy and effectiveness of AF ablation to decrease the incidence of hard outcomes, such as all‐cause mortality, stroke, and heart failure (HF) hospitalizations, however, is less consistent, especially for long‐term follow up 3 . As AF ablation is increasingly utilized as a treatment option for patients with AF 4 and indications for its use are being widened to AF patients with additional comorbidities, 1 an understanding of the long‐term effectiveness of AF ablation is warranted.…”

“…In this issue of the Journal of Cardiovascular Electrophysiology , Saglietto et al 3 conducted a meta‐analysis of randomized controlled trials and observational studies with greater than 2 years of follow up to specifically evaluate the association between AF ablation and all‐cause mortality, stroke, and HF hospitalizations. Only one randomized trial, catheter ablation versus antiarrhythmic drug therapy for atrial fibrillation (CABANA) trial, 5 and eight large observational studies were included (N = 241 372 patients) and study follow up ranged from 2.1 to 4 years 3 .…”

“…In this issue of the Journal of Cardiovascular Electrophysiology , Saglietto et al 3 conducted a meta‐analysis of randomized controlled trials and observational studies with greater than 2 years of follow up to specifically evaluate the association between AF ablation and all‐cause mortality, stroke, and HF hospitalizations. Only one randomized trial, catheter ablation versus antiarrhythmic drug therapy for atrial fibrillation (CABANA) trial, 5 and eight large observational studies were included (N = 241 372 patients) and study follow up ranged from 2.1 to 4 years 3 . After pooling the effect estimates with the random effects model, AF ablation was associated with a reduction in the incidence of all‐cause mortality (hazard ratio [HR], 0.62 [95% confidence interval [CI], 0.54‐0.72]), stroke (HR, 0.63 [95% CI, 0.56‐0.70]), and HF hospitalization (HR, 0.64 [95% CI, 0.51‐0.80]); which translates to a greater than 35% decrease for each individual event when treated with AF ablation compared with medical therapy 3 .…”

“…Only one randomized trial, catheter ablation versus antiarrhythmic drug therapy for atrial fibrillation (CABANA) trial, 5 and eight large observational studies were included (N = 241 372 patients) and study follow up ranged from 2.1 to 4 years 3 . After pooling the effect estimates with the random effects model, AF ablation was associated with a reduction in the incidence of all‐cause mortality (hazard ratio [HR], 0.62 [95% confidence interval [CI], 0.54‐0.72]), stroke (HR, 0.63 [95% CI, 0.56‐0.70]), and HF hospitalization (HR, 0.64 [95% CI, 0.51‐0.80]); which translates to a greater than 35% decrease for each individual event when treated with AF ablation compared with medical therapy 3 . Pooled effect estimates were primarily driven by the observational studies (weight of CABANA estimates between 0.7% and 10.7%).…”