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Catheter ablation reduces all-cause mortality risk in AF-HF patients

Dr Michelle Samuel, McGill University Health Centre, Canada
ESC 2019
Catheter ablation has been associated with a reduced risk of all-cause mortality compared with patients who did not undergo this procedure in a matched population-based atrial fibrillation (AF)-heart failure (HF) cohort. Regarding HF hospitalisations, stroke/ transient ischemic attack (TIA) and major bleeding, no difference in risk was detected between patients who underwent catheter ablation and those who did not. Nevertheless, researchers pointed out that larger studies are warranted to further assess this matter.

Dr Michelle Samuel (McGill University Health Centre, Canada) and colleagues evaluated the long-term effectiveness of catheter ablation in patients with AF-HF in reducing the incidence of all-cause mortality, HF hospitalisations, and major morbidities (i.e. stroke/TIA and major bleeding) [1]. A population-based administrative cohort of 87,676 AF-HF patients was created for this purpose . Patients who underwent catheter ablation (n=298) were matched 1:2 to controls (n=591) using risk-set sampling. Cases were matched on time in the cohort and frequency of hospitalisations.

After inverse probability of treatment weighting, the distribution of covariates was balanced between cases and controls with age 65.6 vs 61.6 years, women 24% vs 20%, CHA2DS2-Vasc score 3.2 vs 2.9, and catheter ablation vs non-catheter ablation, respectively (standardised mean differences was <0.1 for all). The median follow-up was 3.3 years. A total of 7.3% of catheter ablation patients died vs 24.6% of non-catheter ablation patients. After weighting and adjustment, catheter ablation was associated with a statistically significant reduction in the incidence of all-cause mortality (adjusted HR 0.5). No statistically significant difference was observed in the incidence of HF hospitalisations during follow-up (catheter ablation 22.5% vs non-catheter ablation 27.1%; adjusted HR 0.9). The incidence of stroke/TIA (1.7% vs 6.8%) and major bleeding (1.7% vs 4.9%) in patients who had catheter ablation compared with those who had not, were not statistically different.

1. Samuel M, et al. Catheter ablation is associated with reduced all-cause mortality in a real-world cohort of patients with atrial fibrillation and heart failure. FP Number P1024. ESC Congress 2019, 31 Aug-4 Sept, Paris, France.

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