A comparison of the real world effectiveness of catheter ablation and drug therapy in atrial fibrillation patients in a Chinese setting

• Published in: BMC cardiovascular disorders Vol. 17; no. 1; p. 204
• Main Authors: Du, Xin, Guo, Lizhu, He, Xiaonan, Jia, Yu, Wu, Jiahui, Long, Deyong, Yu, Ronghui, Sang, Caihua, Liu, Xiaohui, Yin, Hongjun, Xuan, Jianwei, Dong, Jianzeng, Ma, Changsheng
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 27.07.2017; BioMed Central; BMC
• Subjects: Aged; Anti-Arrhythmia Agents - adverse effects; Anti-Arrhythmia Agents - therapeutic use; Anti-arrhythmic drugs; Atrial fibrillation; Atrial Fibrillation - diagnosis; Atrial Fibrillation - physiopathology; Atrial Fibrillation - therapy; Cardiac arrhythmia; Care and treatment; Catheter ablation; Catheter Ablation - adverse effects; Catheters; China; Chinese; Comparative analysis; Data analysis; Disease; Disease-Free Survival; Drug dosages; Drug therapy; Enrollments; Female; Fibrillation; Heart Conduction System - drug effects; Heart Conduction System - physiopathology; Heart Conduction System - surgery; Heart failure; Heart Rate - drug effects; Hospitals; Humans; Kaplan-Meier Estimate; Logistic Models; Male; Mortality; Multivariate Analysis; Patient outcomes; Patients; Propensity Score; Proportional Hazards Models; Prospective Studies; Quality of Life; Radiofrequency ablation; Recurrence; Risk Factors; Time Factors; Treatment Outcome; China; Anti-arrhythmic drugs; Chinese; Atrial fibrillation; Catheter ablation; Quality of life
• ISSN: 1471-2261; 1471-2261
• DOI: 10.1186/s12872-017-0634-y

Studies have demonstrated that catheter ablation of atrial fibrillation is associated with better rhythm control than drug therapy. The present study aimed to assess the clinical outcomes and health-related quality of life of ablation therapy in a real world setting. A prospective, non-randomized, single center study in a real-world clinical setting in China was conducted. Patients were followed up at 3, 6, and 9 months after baseline encounter. Propensity score matched patients receiving ablation or anti-arrhythmic drug therapy were compared. Incidence rate of atrial fibrillation recurrence and quality of life outcomes were measured and analyzed using log-rank test, multivariate logistic regression and mixed-effects linear regression respectively. In this study, 151 atrial fibrillation patients treated by ablation therapy and 318 patients treated by anti-arrhythmic drugs were enrolled. During follow up, 82.0% in the ablation arm and 22.4% in the drug arm had no documented atrial fibrillation recurrence [HR for atrial fibrillation recurrence 0.07 (95%CI: 0.02-0.21, p < 0.0001)] among paroxysmal atrial fibrillation patients. The corresponding no recurrent rate were 66.7% and 18.5% [0.21 (0.05-0.95, p = 0.04)] respectively among persistent atrial fibrillation patients. Improvement in Short Form-36 physical component scores, Short Form-36 mental component scores and total Atrial Fibrillation Effect on Quality-of-life scores were 16.33 (14.05-18.61, p < 0.001), 8.10 (6.11-10.09, p < 0.001) and 18.28 (16.11-20.45, p < 0.001) respectively among paroxysmal AF patients and 6.32 (3.15-9.49, p < 0.001), 3.99 (1.82-6.16, p < 0.001) and 13.97 (10.89-17.05, p < 0.001) respectively among persistent AF patients. Improvements in total Atrial Fibrillation Effect on Quality-of-life score were also significant in ablation arm while no significant improvement of total Atrial Fibrillation Effect on Quality-of-life score in the drug arm. Compared with drug therapy, catheter ablation is associated with significant lower AF recurrence and improved overall quality of life. The present study has been registered on clinicaltrials.gov. The ClinicalTrials.gov ID is NCT01878981 . The registration date is May 29, 2013.