INTRODUCTION
Atrial fibrillation (AF) has attracted significant attention as a major risk factor for ischemic stroke, heart failure, and death. In fact, AF was independently associated with a 5-fold stroke risk, a 3-fold heart failure risk, and a 1.5–1.9-fold mortality risk based on large cohort studies.1-3 Although the elimination of AF by catheter ablation has been theoretically expected to reduce cardiovascular events and improve survival, the effect of sinus rhythm maintenance on the hard endpoints is not fully elucidated.
Considering the low incidence of major adverse cardiac and cerebrovascular events or death after catheter ablation of AF, a large population of AF ablation may be required to determine the effect of sinus rhythm maintenance on the hard endpoints. However, the identification of AF recurrence in large database-based registries is challenging. In fact, several large propensity-matched registry-based cohort studies4-8 have shown that catheter ablation of AF is significantly associated with a lower incidence of stroke, heart failure, and death compared with medical therapy alone. However, most of those studies lacked information on AF recurrence after catheter ablation, leaving unclear the impact of sinus rhythm maintenance on these adverse events. Although a few old retrospective studies have reported the impact of sinus rhythm maintenance after catheter ablation on clinical outcomes, the data from a large multicenter registry cohort in the era of direct oral anticoagulation (DOAC) is scarce.
To address this issue, we analyzed the data from the Atrial Fibrillation registry to Follow the long-teRm Outcomes and use of aNTIcoagulants aftER Ablation (AF Frontier Ablation Registry).