Patients Treated with Catheter Ablation for Atrial Fibrillation Have Long‐Term Rates of Death, Stroke, and Dementia Similar to Patients Without Atrial Fibrillation

Bunch, T. Jared; Crandall, Brian G.; Weiss, J. Peter; May, Heidi T.; Bair, Tami L; Osborn, Jeffrey S.; Anderson, Jeffrey L.; Muhlestein, Joseph B.; Horne, Michael; Lappé, Donald; Day, John D.

doi:10.1111/j.1540-8167.2011.02035.x

Cited by 357 publications

(250 citation statements)

References 42 publications

(82 reference statements)

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“…239,1112,1113,1114 In a very large, prospectively collected registry (the Intermountain Healthcare Database in Utah), investigators reported a significantly lower rate of stroke in 4212 ablated patients (follow-up 3.1 ± 2.4 years), compared with those who did not undergo ablation. 239 Moreover, ablated patients had comparable stroke rates when compared with age- and sex-matched patients who did not have a history of AF. Both observations were independent of baseline stroke risk score.…”

Section: Outcomes Of Af Ablation In Populations Not Well Represented mentioning

confidence: 99%

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

Calkins,

Kuck,

Cappato

et al. 2012

Heart Rhythm

1,769

1,468

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Section: Outcomes Of Af Ablation In Populations Not Well Represented mentioning

confidence: 99%

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

Calkins,

Kuck,

Cappato

et al. 2012

Heart Rhythm

1,769

1,468

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“…Bunch age/gender matched controls without AF. 36 The results showed that AF ablation patients have a significantly lower risk of death, stroke …”

Section: Could Catheter Ablation Of Atrial Fibrillation Reduce Long-tmentioning

confidence: 89%

Stroke in Atrial Fibrillation – Long-term Follow-up of Cardiovascular Events

Chao

Chiang

Chen

2013

Arrhythmia &Amp; Electrophysiology Review

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Atrial fibrillation (AF) is the most common sustained arrhythmia in clinical practice, accounting for approximately one-third of hospitalisations for cardiac rhythm disturbances.1 Between 1980 and 2000, the age-adjusted incidence of AF significantly increased from 3.04 to 3.68 per 1,000 person-years in the US. 2 The prevalence of AF was lower among African Americans than among Caucasians, 3 and it also seemed to be lower in the Asian population. 4,5 In a nationwide cohort of 702,502 participants in Taiwan, the AF incidence was around 1.5 per 1,000 person-years. 6 Since a considerable number of AF patients was paroxysmal in nature, the incidence and prevalence of AF could be significantly underestimated.Systemic thromboembolism is the most severe complication of AF. It accounts for about 15-20 % of ischaemic strokes.7 AF-related strokes were associated with a poor prognosis as more than 50 % of the survivors remain with a severe deficit, and recurrence may be as high as 12 % per year. 8 The risk of AF-related stroke was higher in Caucasian populations than in Asians populations (see Figure 1). 4,[9][10][11][12][13][14][15] AF could in fact drive a prothrombotic or hypercoagulable state, by virtue of its fulfilment of Virchow's triad for thrombogenesis (blood stasis, endocardial dysfunction/damage, and abnormal haemostasis). The most important point in determining the strategy of stroke prevention for AF is how to estimate the thromboembolic (TE) risk accurately. The CHADS 2 score is the most commonly used scheme in stroke risk stratifications for AF patients, 17 despite the fact that it classifies a large proportion of patients as being at 'intermediate risk', and several important TE risk factors were omitted in the scoring system. 18 Recently, a newly developed scoring system, CHA 2 DS 2 -VASc score, which extends the CHADS 2 scheme by considering additional stroke risk factors (vascular diseases and female gender) was recommended to be used to guide the antithrombotic therapies for AF patients. 19,20 The CHA 2 DS 2 -VASc score is most useful in identifying truly low-risk patients, and no antithrombotic therapy is necessary for patients with a CHA 2 DS 2 -VASc score of 0. [21][22][23] In the study performed by Taillandier et al., which enrolled a total of 616 AF patients with a CHA 2 DS 2 -VASc score of 0, an OAC was prescribed on an individual basis in 273 patients (44 %), antiplatelet therapy alone in 145 patients (24 %), and no antithrombotic therapy in 198 patients (32 %).22 During a follow-up of 876 ± 1,135 days, 38 patients experienced adverse events (10 stroke/thromboembolism, 19 major bleeding, 17 deaths). Prescription of OACs and/or antiplatelet therapy was not associated with an improved prognosis for stroke/thromboembolism (relative risk: 0.99, 95 % confidence interval: 0.25-3.99, p-value: 0.99), nor improved survival or net clinical benefit (combination of stroke/ thromboembolism, bleeding and death). More recently, a nationwide cohort study in Taiwan further demonstrated that AF males with a CHA 2 ...

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“…[1] Catheter ablation, which is centered on electrical isolation of triggering foci within the pulmonary veins (PV) through circumferential lesions around PV ostia, has been shown to result in sustained improvements in quality of life, decreased hospitalizations and, potentially, improved survival. [4-6]…”

Section: Introductionmentioning

confidence: 99%

Cryoballoon Ablation for Atrial Fibrillation

Andrade

Dubuc

Guerra

et al. 2012

Indian Pacing and Electrophysiology Journal

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Focal point-by-point radiofrequency catheter ablation has shown considerable success in the treatment of paroxysmal atrial fibrillation. However, it is not without limitations. Recent clinical and preclinical studies have demonstrated that cryothermal ablation using a balloon catheter (Artic Front©, Medtronic CryoCath LP) provides an effective alternative strategy to treating atrial fibrillation. The objective of this article is to review efficacy and safety data surrounding cryoballoon ablation for paroxysmal and persistent atrial fibrillation. In addition, a practical step-by-step approach to cryoballoon ablation is presented, while highlighting relevant literature regarding: 1) the rationale for adjunctive imaging, 2) selection of an appropriate cryoballoon size, 3) predictors of efficacy, 4) advanced trouble-shooting techniques, and 5) strategies to reduce procedural complications, such as phrenic nerve palsy.

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Patients Treated with Catheter Ablation for Atrial Fibrillation Have Long‐Term Rates of Death, Stroke, and Dementia Similar to Patients Without Atrial Fibrillation

Abstract: AF ablation patients have a significantly lower risk of death, stroke, and dementia in comparison to AF patients without ablation. AF ablation may eliminate the increased risk of death and stroke associated with AF.

Cited by 357 publications

References 42 publications

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

Stroke in Atrial Fibrillation – Long-term Follow-up of Cardiovascular Events

Cryoballoon Ablation for Atrial Fibrillation

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