Impact of early ablation of atrial fibrillation on long-term outcomes: results from phase II/III of the GLORIA-AF registry

Abstract

Background First-line ablation for atrial fibrillation (AF) reduces the risk of recurrent atrial arrhythmias compared to medical therapy. However, the prognostic benefit of early AF ablation remains undetermined. Herein, we aimed to evaluate the effects of early AF ablation compared to medical therapy. Methods Using data from phase II/III of the GLORIA-AF registry, we studied patients who were consecutively enrolled with newly diagnosed AF (< 3 months before baseline visit) and an increased risk of stroke (CHA2DS2–VASc ≥ 1). At baseline visit, 445 (1.7%) patients were treated with early AF ablation and 25,518 (98.3%) with medical therapy. Outcomes of interest were the composite outcome of all-cause death, stroke and major bleeding, and pre-specified outcomes of all-cause death, cardiovascular (CV) death, non-CV death, stroke and major bleeding. Results A total of 25,963 patients (11733 [45.2%] females; median age 71 [IQR 64–78] years; 17424 [67.1%] taking non-vitamin K antagonist oral anticoagulants [NOACs]) were included. Over a follow-up period of 3.0 (IQR 2.3–3.1) years, after adjustment for confounders, early AF ablation was associated with a significant reduction in the composite outcome of all-cause death, stroke and major bleeding (HR 0.50 [95% CI 0.30–0.85]) and all-cause death (HR 0.45 [95% CI 0.23–0.91]). There were no statistical differences between the groups in terms of CV death, non-CV death, stroke and major bleeding. Similar results were obtained in a propensity-score matched analysis of patients with comparable baseline variables. Conclusions Early AF ablation in a contemporary prospective cohort of AF patients who were predominantly treated with NOACs was associated with a survival advantage compared to medical therapy alone. Trial registration Clinical trial registration: http://www.clinicaltrials.gov. Unique identifiers: NCT01468701, NCT01671007 and NCT01937377. Graphical abstract Created with BioRender.com.

Clinical Complexity Domains, Anticoagulation, and Outcomes in Patients with Atrial Fibrillation: A Report from the GLORIA-AF Registry Phase II and III

“…The GLORIA-AF is a global, multicenter prospective registry structured in three phases, which aims to evaluate the longterm safety and effectiveness of dabigatran in real-world patients with AF. Complete details on the design of the GLORIA-AF study have been previously reported, 20,21 as well as the primary papers comparing dabigatran versus VKA and other NOACs. 22,23 Briefly, patients with new-onset nonvalvular AF and CHA 2 DS 2 -VASc score !1 were consecutively enrolled between 2011 and 2016 (2011-2014 for phase II, and 2014-2016 for phase III).…”

Impact of Catheter Ablation on Long-Term Outcomes in Patients With Atrial Fibrillation: A Meta-Analysis

“…A total of 10 studies compared the stroke between patients who received catheter ablation and patients who did not receive ablation [12,[13][14][15][16][17][18][19][20][21]. By random-effect model meta-analysis, catheter-based AF ablation reduced the risk of stroke by 39% (HR: 0.61, 95% CI: 0.49-0.77) compared with patients treated with medical therapy as shown in Figure 2.…”

“…Sources: References [12][13][14][15][16][17][18][19][20][21] A total of eight studies assessed the all-cause mortality between the study groups [12][13][14][15]17,[19][20][21]. The risk of all-cause mortality was significantly lower in patients receiving catheter-based AF ablation compared to patients treated with medical therapy (HR: 0.60, 95% CI: 0.51-0.71) as shown in Figure 3.…”

“…The risk of major bleeding events was assessed by three studies in the current meta-analysis [ 14 , 16 - 17 ]. No significant difference was found between the two study groups in terms of major bleeding events (HR: 0.96, 95% CI: 0.80-1.14) as shown in Figure 5 .…”

“…FIGURE 3: Forest plots comparing ablation vs. no ablation groups in terms of risk of all-cause mortalitySources: References[12][13][14][15]17,[19][20][21] …”