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).