Does Catheter Ablation Lower the Long-Term Risk of Stroke and Mortality in Patients with Atrial Fibrillation? A Concise Review of the Current State of Knowledge.

Robert Ryad,Therese Limbana,Farah Khan,Nusrat Jahan,Suhail M Saad-Omer

doi:10.7759/cureus.9701

Abstract

Atrial fibrillation (AF) is the most common cardiac arrhythmia worldwide and carries a significant risk of morbidity and mortality. Multiple trials have highlighted the benefit of catheter ablation over medical therapy in restoring sinus rhythm and improving quality of life. Whether it reduces long-term risk of stroke and mortality is still unclear.We performed a literature search using the PubMed database to review the current state of knowledge regarding the long-term outcomes of stroke and mortality in ablated patients compared to patients who receive medical therapy. Our review mainly consisted of recent randomized controlled trials and large observational studies. Results from large observational studies show that catheter ablation significantly reduces the risk of stroke in high-risk patients and mortality compared to medical therapy. However, randomized controlled trials have only demonstrated a mortality benefit in patients with comorbid systolic heart failure. In patients with paroxysmal AF, ablation therapy significantly limits the progression to persistent AF and has a higher efficacy in restoring sinus rhythm. Maintenance of sinus rhythm is the most important factor associated with lower long term risk of stroke and mortality.Large randomized controlled trials similar to the Catheter Ablation Versus Anti-arrhythmic Drug Therapy for Atrial Fibrillation (CABANA) trial are still needed to clarify whether catheter ablation is superior over medical therapy in improving the long-term outcomes of stroke and mortality.

Highlights

BackgroundAtrial fibrillation (AF) is the most common cardiac arrhythmia and is regarded as a future epidemic among aging populations with an estimated worldwide prevalence of 0.51% and consistently increasing incidence rates [1]
We review the current evidence to highlight whether there is any long-term benefit of catheter ablation over antiarrhythmic drug therapy
In the analysis of selected articles for the presented literature, we found sufficient evidence of the long-term benefit of catheter ablation in specific sub-populations of AF patients

Summary

Introduction

Atrial fibrillation (AF) is the most common cardiac arrhythmia and is regarded as a future epidemic among aging populations with an estimated worldwide prevalence of 0.51% and consistently increasing incidence rates [1] It imposes a five-fold increased risk of stroke and a two-fold increased risk of dementia and mortality [2,3]. We review the current evidence to highlight whether there is any long-term benefit of catheter ablation over antiarrhythmic drug therapy. How to cite this article Ryad R, Saad-Omer S M, Khan F, et al (August 12, 2020) Does Catheter Ablation Lower the Long-Term Risk of Stroke and Mortality in Patients with Atrial Fibrillation? In the analysis of selected articles for the presented literature, we found sufficient evidence of the long-term benefit of catheter ablation in specific sub-populations of AF patients.

Study Design

Conclusions

Findings

Disclosures