Abstract
BackgroundAtrial fibrillation (AF) is an important risk factor for thromboembolic events, for which catheter ablation represents an effective therapy for rhythm control. Intuitively, ablation may reduce the incidence of thromboembolism, but data is quite limited.HypothesisCatheter ablation was associated with the fewer risk of thromboembolism compared with nonablation in patients with AF.MethodsA systematic search was performed in PubMed, EMBASE, the Web of Science, and the Cochrane Library from inception to September 2019. Random‐effects model was used to estimate the risk ratios (RR) for the thromboembolic events between the ablation and nonablation groups.ResultsTwenty‐five studies (12 randomized controlled trials and 13 observational studies) with 104 687 participants were included. Pooled analysis suggested that ablation was associated with a 35% lower risk of total thromboembolic events compared to nonablation group (RR = 0.65; 95% CI, 0.51‐0.82; P = .0003). When separated into early‐phase (<30 days) and late‐phase (>30 days) events, ablation was associated with an increased early‐phase thromboembolism (RR = 1.96; 95% CI, 1.35‐2.83; P = .0004) but a decreased late‐phase thromboembolism (RR = 0.75; 95% CI, 0.63‐0.90; P = .002). Subgroup analysis according to different study types found similar results were found in observation studies, but not in RCT studies because the sample size was too small to be conclusive.ConclusionsIn patients with AF, catheter ablation was associated with a fewer risk of overall and late‐phase thromboembolism in comparison with nonablation. However, over the early postoperative period, catheter ablation was associated with the double higher risk of thromboembolic events.
Highlights
Atrial fibrillation (AF), the most common form of cardiac arrhythmia, is an important risk factor for thromboembolic events, especially for ischemic stroke.[1,2] Thrombosis formation in patients with AF is mainly associated with slow blood flow and stasis of the left atrial appendage secondary to the loss of atrial rhythmic mechanical contraction.[3]
A total of 2330 articles were initially retrieved from PubMed, EMBASE, the Web of Science, and the Cochrane Library
In the five balanced CHADS2/CHA2DS2-VASc scores studies, further analysis showed catheter ablation was associated with a fewer risk of late-phase thromboembolic events in comparison with nonablation (RR = 0.79; 95% confidence interval (CI), 0.64-0.98; P = .03; I2 = 0%), no differences were found in the randomized controlled trials (RCTs) subgroup (RR = 0.68; 95% CI, 0.41-1.13; P = .13; I2 = 0%) and in the observational study subgroup (RR = 0.82; 95% CI, 0.65-1.04; P = .10; I2 = 0%; Figure S4)
Summary
Atrial fibrillation (AF), the most common form of cardiac arrhythmia, is an important risk factor for thromboembolic events, especially for ischemic stroke.[1,2] Thrombosis formation in patients with AF is mainly associated with slow blood flow and stasis of the left atrial appendage secondary to the loss of atrial rhythmic mechanical contraction.[3] Based on this mechanism of thrombosis, effective rhythm control may reduce the incidence of thromboembolic events. An effective method to restore and maintain sinus rhythm in patients with nonvalvular AF (NVAF),[4] might reduce thromboembolic events following effective rhythm control. A modified version of the Newcastle-Ottawa scale, which is a quality assessment tool for nonrandomized studies, was applied to appraise the quality of cohort studies or case-control studies in three domains: the selection of participants, comparability of study groups, and the outcome of interest.[15]
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