Does atrial fibrillation ablation really reduce stroke rates?

Abstract

less frequently than those treated with antiarrhythmic medications (14 of 589 [2.4%] vs 49 of 582 [8.4%]). However, that was a nonrandomized study from a single center and may have had a lot of confounders and selection bias. In this issue of HeartRhythm, Bunch et al 14 report that patients undergoing AF ablation have lower stroke rates during a long-term follow-up of more than 3 years than do patients who do not undergo AF ablation and the risk is similar to that of patients without a history of AF. Their results had 3 key implications. Their data were obtained from a large system-wide study derived from a prospectively collected registry and, therefore, may reflect a real-world cohort more adequately than did the data from other trials. In fact, the stroke rate at 1 year in their study is 3.5% in patients with AF who did not undergo ablation, which is well in line with the stroke rates of 2%–6% in patients treated mostly with anticoagulants and who had a mild to moderate risk in large-scale trials. 6,13,15,16 In addition, their patient groups were matched by age and sex, and although there was a small difference in the baseline risk between groups, the reduction in the stroke rate in the AF ablation group persisted after a multivariate adjustment for the confounding variables. Two recent studies from a large age- and sex-matched 15 or propensity-matched community sample 16 also showed comparative results in which the stroke rate in the ablation group with an ablation strategy was associated with a lower stroke rate as compared to patients treated with antiarrhythmic medications and who had no difference from that of the general population. Taken together, this suggests that the maintenance of sinus rhythm after ablation may be significantly more reduced than after antiarrhythmic medications