Prognostic impact of catheter ablation in patients with asymptomatic atrial fibrillation

• Published in: PloS one Vol. 17; no. 12; p. e0279178
• Main Authors: Kawaji, Tetsuma, Shizuta, Satoshi, Tanaka, Munekazu, Nishiwaki, Shushi, Aizawa, Takanori, Yamagami, Shintaro, Komasa, Akihiro, Yoshizawa, Takashi, Kato, Masashi, Yokomatsu, Takafumi, Miki, Shinji, Ono, Koh, Kimura, Takeshi
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 15.12.2022; Public Library of Science (PLoS)
• Subjects: Ablation; Ablation (Surgery); Asymptomatic; Atrial Fibrillation; Biology and Life Sciences; Cardiac arrhythmia; Care and treatment; Catheter Ablation - adverse effects; Catheters; Clinical outcomes; Complications; Complications and side effects; Congestive heart failure; Diagnosis; Engineering and Technology; Fibrillation; Heart Failure; Hospitalization; Humans; Ischemia; Ischemic Stroke - complications; Medical instruments; Medical prognosis; Medicine and Health Sciences; Patients; People and Places; Prognosis; Radiofrequency ablation; Risk Factors; Stroke; Stroke - epidemiology; Time Factors; Treatment Outcome; Japan; United States > US
• DOI: 10.1371/journal.pone.0279178
• ISSN: 1932-6203

Catheter ablation for asymptomatic atrial fibrillation (AF) remains controversial. The aim of the present study was to explore the prognostic impact of catheter ablation in asymptomatic AF patients. We performed a post-hoc analysis of 537 risk-matched pairs of AF patients receiving first-time catheter ablation or conservative management. The primary outcome measure was a composite of cardiovascular death, heart failure (HF) hospitalization, ischemic stroke, or major bleeding. The study patients were divided into asymptomatic and symptomatic patients, and were further divided according to the presence or absence of previous AF-related complications (ischemic stroke or HF hospitalization). Most baseline characteristics were well balanced between the catheter ablation versus conservative management groups. The median follow-up period was 5.3 years. Catheter ablation as compared to conservative management was associated with significantly lower incidence of the primary outcome measure in the asymptomatic AF patients (14.7% versus 25.4% at 8-year, log-rank P = 0.008). However, the advantage of catheter ablation was significant only in the high-risk subset of patients with the previous AF-related complications (19.2% versus 55.6% at 8-year, log-rank P = 0.006), but not in those without (13.9% and 17.3%, P = 0.08). On the other hand, among the symptomatic AF patients, catheter ablation was associated with significantly lower incidence of the primary outcome measure regardless of the previous AF-related complications. In the post-hoc analysis of the matched AF cohort, catheter ablation as compared with conservative management was associated with better long-term clinical outcomes among asymptomatic AF patients only when the previous AF-related complications were present.