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      Catheter Ablation Improves Mortality and Other Outcomes in Real‐World Patients With Atrial Fibrillation

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          Abstract

          Background

          It is still controversial whether catheter ablation for atrial fibrillation ( AF) improves survival and other outcomes in patients with AF. This study evaluated whether ablation reduces death and other events in nationwide real‐world Asian patients with AF.

          Methods and Results

          From the Korean National Health Insurance Service database, 194 928 adult patients (aged ≥18 years) with newly diagnosed AF were treated with ablation or medical therapy (antiarrhythmic or rate control drugs) between January 1, 2005, and December 1, 2015. Among these patients, this study included 9185 with ablation and 18 770 with medical therapy. The time at risk was counted from the first medical therapy, and ablation was analyzed as a time‐varying covariate. Inverse probability of treatment weighting was used to correct for differences between the groups. After weighting, the 2 cohorts had similar background characteristics. During a median (25th, 75th percentiles) follow‐up of 43 (19, 81) months, ablation of AF was associated with lower incidence and risk of composite outcome, including death, heart failure admission, and stroke/systemic embolism (2.5 and 6.4 per 100 person‐years, respectively; hazard ratio [HR], 0.47; 95% CI, 0.43–0.52; P<0.001), all‐cause death (1.0 and 3.6 per 100 person‐years; HR, 0.41; 95% CI, 0.36–0.47; P<0.001), heart failure admission (0.7 and 1.9 per 100 person‐years; HR, 0.43; 95% CI, 0.37–0.50), and ischemic stroke/systemic embolism (1.1 and 2.8 per 100 person‐years; HR, 0.39; 95% CI, 0.34–0.44) than medical therapy.

          Conclusions

          Ablation may be associated with lower risk of death, heart failure admission, and ischemic stroke/systemic embolism in real‐world Asian patients with AF.

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          Most cited references13

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          A population-based study of the long-term risks associated with atrial fibrillation: 20-year follow-up of the Renfrew/Paisley study.

          To describe the effect of atrial fibrillation on long-term morbidity and mortality. The Renfrew/Paisley Study surveyed 7052 men and 8354 women aged 45-64 years between 1972 and 1976. All hospitalizations and deaths occurring during the subsequent 20 years were analyzed by the presence or absence of atrial fibrillation at baseline. Lone atrial fibrillation was defined in the absence of other cardiovascular signs or symptoms. Cox proportional hazards models were used to adjust for age and cardiovascular conditions. After 20 years, 42 (89%) of the 47 women with atrial fibrillation had a cardiovascular event (death or hospitalization), compared with 2276 (27%) of the 8307 women without this arrhythmia. Among men, 35 (66%) of 53 with atrial fibrillation had an event, compared with 3151 (45%) of 6999 without atrial fibrillation. In women, atrial fibrillation was an independent predictor of cardiovascular events (rate ratio [RR] = 3.0; 95% confidence interval [CI]: 2.1-4.2), fatal or nonfatal strokes (RR = 3.2; 95% CI: 1.0-5.0), and heart failure (RR = 3.4; 95% CI: 1.9-6.2). The rate ratios among men were 1.8 (95% CI: 1.3-2.5) for cardiovascular events, 2.5 (95% CI: 1.3-4.8) for strokes, and 3.4 (95% CI: 1.7-6.8) for heart failure. Atrial fibrillation was an independent predictor of all-cause mortality in women (RR = 2.2; 95% CI: 1.5-3.2) and men (RR = 1.5; 95% CI: 1.2-2.2). However, lone atrial fibrillation (which occurred in 15 subjects) was not associated with a statistically significant increase in either cardiovascular events (RR = 1.5; 95% CI: 0.6-3.6) or mortality (RR = 1.8; 95% CI: 0.9-3.8). Atrial fibrillation is associated with an increased long-term risk of stroke, heart failure, and all-cause mortality, especially in women.
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            Catheter ablation for atrial fibrillation in congestive heart failure.

            Congestive heart failure and atrial fibrillation often coexist, and each adversely affects the other with respect to management and prognosis. We prospectively evaluated the effect of catheter ablation for atrial fibrillation on left ventricular function in patients with heart failure. We studied 58 consecutive patients with congestive heart failure and a left ventricular ejection fraction of less than 45 percent who were undergoing catheter ablation for atrial fibrillation. We selected as controls 58 patients without congestive heart failure who were undergoing ablation for atrial fibrillation, matched according to age, sex, and classification of atrial fibrillation. We evaluated the patients' left ventricular function and dimensions, symptom score, exercise capacity, and quality of life at baseline and at months 1, 3, 6, and 12. After a mean (+/-SD) of 12+/-7 months, 78 percent of the patients with congestive heart failure and 84 percent of the controls remained in sinus rhythm (P=0.34) (69 percent and 71 percent, respectively, were in sinus rhythm without the administration of antiarrhythmic drugs). The patients with congestive heart failure had significant improvement in left ventricular function (increases in the ejection fraction and fractional shortening of 21+/-13 percent and 11+/-7 percent, respectively; P<0.001 for both comparisons), left ventricular dimensions (decreases in the diastolic and systolic diameters of 6+/-6 mm and 8+/-7 mm, respectively; P=0.03 and P<0.001, respectively), exercise capacity, symptoms, and quality of life. The ejection fraction improved significantly not only in patients without concurrent structural heart disease (24+/-10 percent, P<0.001) and those with inadequate rate control before ablation (23+/-10 percent, P<0.001), but also in those with coexisting heart disease (16+/-14 percent, P<0.001) and adequate rate control before ablation (17+/-15 percent, P<0.001). Restoration and maintenance of sinus rhythm by catheter ablation without the use of drugs in patients with congestive heart failure and atrial fibrillation significantly improve cardiac function, symptoms, exercise capacity, and quality of life. Copyright 2004 Massachusetts Medical Society.
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              Risk of dementia in stroke-free patients diagnosed with atrial fibrillation: data from a population-based cohort

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                Author and article information

                Contributors
                cby6908@yuhs.ac
                Journal
                J Am Heart Assoc
                J Am Heart Assoc
                10.1002/(ISSN)2047-9980
                JAH3
                ahaoa
                Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
                John Wiley and Sons Inc. (Hoboken )
                2047-9980
                28 May 2020
                02 June 2020
                : 9
                : 11 ( doiID: 10.1002/jah3.v9.11 )
                : e015740
                Affiliations
                [ 1 ] Department of Cardiology CHA Bundang Medical Center CHA University Seongnam Republic of Korea
                [ 2 ] Division of Cardiology Department of Internal Medicine Yonsei University College of Medicine Seoul Republic of Korea
                Author notes
                [*] [* ]Correspondence to: Boyoung Joung, MD, PhD, 50‐1 Yonsei‐ro, Seodaemun‐gu, Seoul, Republic of Korea 03722. E‐mail: cby6908@ 123456yuhs.ac
                [†]

                Dr Yang and Dr Sung contributed equally to this work.

                Article
                JAH35080
                10.1161/JAHA.119.015740
                7429005
                32427022
                cf3c0828-b745-45f6-b324-27f491aadf1f
                © 2020 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                : 30 December 2019
                : 25 March 2020
                Page count
                Figures: 5, Tables: 2, Pages: 21, Words: 6405
                Funding
                Funded by: The Ministry of Health and Welfare, Republic of Korea
                Award ID: HI15C1200
                Award ID: HC19C0130
                Categories
                Original Research
                Original Research
                Arrhythmia and Electrophysiology
                Custom metadata
                2.0
                02 June 2020
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.8.5 mode:remove_FC converted:19.07.2020

                Cardiovascular Medicine
                atrial fibrillation,catheter ablation,heart failure,mortality
                Cardiovascular Medicine
                atrial fibrillation, catheter ablation, heart failure, mortality

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