Catheter ablation versus medical therapy for atrial fibrillation with prior stroke history:a prospective propensity score-matched cohort study

BACKGROUND Patients with atrial fibrillation(AF)and prior stroke history have a high risk of cardiovascular events despite anticoagulation therapy.It is unclear whether catheter ablation(CA)has further benefits in these patients.METHODS AF patients with a previous history of stroke or systemic embolism(SE)from the prospective Chinese Atrial Fibrillation Registry study between August 2011 and December 2020 were included in the analysis.Patients were matched in a 1:1 ratio to CA or medical treatment(MT)based on propensity score.The primary outcome was a composite of all-cause death or ischemic stroke(IS)/SE.RESULTS During a total of 4.1±2.3 years of follow-up,the primary outcome occurred in 111 patients in the CA group(3.3 per 100 person-years)and in 229 patients in the MT group(5.7 per 100 person-years).The CA group had a lower risk of the primary outcome compared to the MT group[hazard ratio(HR)=0.59,95%CI:0.47–0.74,P<0.001].There was a significant decreasing risk of all-cause mortality(HR=0.43,95%CI:0.31–0.61,P<0.001),IS/SE(HR=0.73,95%CI:0.54–0.97,P=0.033),cardiovascular mortality(HR=0.32,95%CI:0.19–0.54,P<0.001)and AF recurrence(HR=0.33,95%CI:0.30–0.37,P<0.001)in the CA group compared to that in the MT group.Sensitivity analysis generated consistent results when adjusting for time-dependent usage of anticoagulants.CONCLUSIONS In AF patients with a prior stroke history,CA was associated with a lower combined risk of all-cause death or IS/SE.Further clinical trials are warranted to confirm the benefits of CA in these patients.

Catheter ablation for atrial fibrillation is associated with reduced risk of mortality in the elderly:a prospective cohort study and propensity score analysis

Background It is unclear whether catheter ablation(CA)for atrial fibrillation(AF)affects the long-term prognosis in the elderly.This study aims to evaluate the relationship between CA and long-term outcomes in elderly patients with AF.Methods Patients more than 75 years old with non-valvular AF were prospectively enrolled between August 2011 and December 2017 in the Chinese Atrial Fibrillation Registry Study.Participants who underwent CA at baseline were propensity score matched(1:1)with those who did not receive CA.The outcome events included all-cause mortality,cardiovascular mortality,stroke/transient ischemic attack(TIA),and cardiovascular hospitalization.Results Overall,this cohort included 571 ablated patients and 571 non-ablated patients with similar characteristics on 18 dimensions.During a mean follow-up of 39.75±19.98 months(minimum six months),24 patients died in the ablation group,compared with 60 deaths in the non-ablation group[hazard ratio(HR)=0.49,95%confidence interval(CI):0.30-0.79,P=0.0024].Besides,6 ablated and 29 non-ablated subjects died of cardiovascular disease(HR=0.25,95%CI:0.11-0.61,P=0.0022).A total of 27 ablated and 40 non-ablated patients suffered stroke/TIA(HR=0.79,95%CI:0.48-1.28,P=0.3431).In addition,140 ablated and 194 non-ablated participants suffered cardiovascular hospitalization(HR=0.84,95%CI:0.67-1.04,P=0.1084).Subgroup analyses according to gender,type of AF,time since onset of AF,and anticoagulants exposure in initiation did not show significant heterogeneity.Conclusions In elderly patients with AF,CA may be associated with a lower incidence of all-cause and cardiovascular mortality.

A simple and easily implemented risk model to predict 1-year ischemic stroke and systemic embolism in Chinese patients with atrial fibrillation

Background:Accurate prediction of ischemic stroke is required for deciding anticoagulation use in patients with atrial fibrillation(AF).Even though only 6%to 8%of AF patients die from stroke,about 90%are indicated for anticoagulants according to the current AF management guidelines.Therefore,we aimed to develop an accurate and easy-to-use new risk model for 1-year thromboembolic events(TEs)in Chinese AF patients.Methods:From the prospective China Atrial Fibrillation Registry cohort study,we identified 6601 AF patients who were not treated with anticoagulation or ablation at baseline.We selected the most important variables by the extreme gradient boosting(XGBoost)algorithm and developed a simplified risk model for predicting 1-year TEs.The novel risk score was internally validated using bootstrapping with 1000 replicates and compared with the CHA2DS2-VA score(excluding female sex from the CHA2DS2-VASc score).Results:Up to the follow-up of 1 year,163 TEs(ischemic stroke or systemic embolism)occurred.Using the XGBoost algorithm,we selected the three most important variables(congestive heart failure or left ventricular dysfunction,age,and prior stroke,abbreviated as CAS model)to predict 1-year TE risk.We trained a multivariate Cox regression model and assigned point scores proportional to model coefficients.The CAS scheme classified 30.8%(2033/6601)of the patients as low risk for TE(CAS score=0),with a corresponding 1-year TE risk of 0.81%(95%confidence interval[CI]:0.41%–1.19%).In our cohort,the C-statistic of CAS model was 0.69(95%CI:0.65–0.73),higher than that of CHA2DS2-VA score(0.66,95%CI:0.62–0.70,Z=2.01,P=0.045).The overall net reclassification improvement from CHA2DS2-VA categories(low=0/high≥1)to CAS categories(low=0/high≥1)was 12.2%(95%CI:8.7%–15.7%).Conclusion:In Chinese AF patients,a novel and simple CAS risk model better predicted 1-year TEs than the widely-used CHA2DS2-VA risk score and identified a large proportion of patients with low risk of TEs,which could potentially improve anticoagulation decision-making.Trial Registration:www.chictr.org.cn(Unique identifier No.ChiCTR-OCH-13003729).