ABSTRACT
Introduction: The impact of catheter ablation for atrial
fibrillation (AF) on cardiovascular events and mortality is
controversial. We investigated the impact of sinus rhythm maintenance on
major adverse cardiac and cerebrovascular events after AF ablation from
a Japanese multicenter cohort of AF ablation.
Methods and Results: We investigated 2737 consecutive patients
(25.6% female, mean age 63.4 ± 10.3 years) who underwent a first
catheter ablation for AF from the Atrial Fibrillation registry to Follow
the long-teRm Outcomes and use of aNTIcoagulants aftER Ablation (AF
Frontier Ablation Registry). The primary endpoint was a composite of
stroke, transient ischemic attack, cardiovascular events, and all-cause
death. During a mean follow-up of 25.2 months, 2070 (75.6%) patients
were free from AF after catheter ablation, and the primary composite
endpoint occurred in 122 (4.5%) patients. The AF nonrecurrence group
had a significantly lower incidence of the primary endpoint (1.7 per 100
person-years) compared with the AF recurrence group (3.2 per 100
person-years; P = 0.001). The multivariate analysis revealed that
freedom from AF (hazard ratio 0.57; 95% confidence interval 0.39–0.83;P = 0.003) was independently associated with the incidence of the
composite event.
Conclusion: In the multicenter cohort of AF ablation, sinus
rhythm maintenance after catheter ablation was independently associated
with lower rates of major adverse cardiac and cerebrovascular events.
Keywords: ablation; atrial fibrillation; stroke; cardiovascular
disease; mortality.