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Maintenance of sinus rhythm with an ablation strategy in patients with atrial fibrillation is associated with a lower risk of stroke and death
Abstract
OBJECTIVE: To investigate whether catheter ablation of atrial fibrillation (AF) reduces stroke rate or mortality. METHODS: An international multicentre registry was compiled from seven centres in the U.K. and Australia for consecutive patients undergoing catheter ablation of AF. Long-term outcomes were compared with (1) a cohort with AF treated medically in the Euro Heart Survey, and (2) a hypothetical cohort without AF, age and gender matched to the general population. Analysis of stroke and death was carried out after the first procedure (including peri-procedural events) regardless of success, on an intention-to-treat basis. RESULTS: 1273 patients, aged 58±11 years, 56% paroxysmal AF, CHADS(2) score 0.7±0.9, underwent 1.8±0.9 procedures. Major complications occurred in 5.4% of procedures, including stroke/TIA in 0.7%. Freedom from AF following the last procedure was 85% (76% off antiarrhythmic drugs) for paroxysmal AF, and 72% (60% off antiarrhythmic drugs) for persistent AF. During 3.1 (1.0-9.6) years from the first procedure, freedom from AF predicted stroke-free survival on multivariate analysis (HR=0.30, CI 0.16 to 0.55, p<0.001). Rates of stroke and death were significantly lower in this cohort (both 0.5% per patient-year) compared with those treated medically in the Euro Heart Survey (2.8% and 5.3%, respectively; p<0.0001). Rates of stroke and death were no different from those of the general population (0.4% and 1.0%, respectively). CONCLUSION: Restoration of sinus rhythm by catheter ablation of AF is associated with lower rates of stroke and death compared with patients treated medically.
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“Although observational studies suggest a relatively low stroke rate in the first few years after catheter ablation of AF, 737,[771][772][773][774][775][776]”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [737]
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Metadata
- Authors
- Hunter, R. J., McCready, J., Diab, I., Page, S. P., Finlay, M., Richmond, L., French, A., Earley, M. J., Sporton, S., Jones, M., Joseph, J. P., Bashir, Y., Betts, T. R., Thomas, G., Staniforth, A., Lee, G., Kistler, P., Rajappan, K., Chow, A., & Schilling, R. J.
- Affiliations
- St Bartholomew's Hospital (GB)
- University College Hospital at Westmoreland Street (GB)
- Barts Health NHS Trust (GB)
- John Radcliffe Hospital (GB)
- Nottingham University Hospitals NHS Trust (GB)
- Baker Heart and Diabetes Institute (AU)
- Corresponding author
- Schilling, Richard J
- ORCID
- Venue
- Heart
- Publisher
- BMJ
- Published
- 2011-09-19
- Volume
- 98
- Issue
- 1
- Pages
- 48-53
- ISSN
- 1355-6037 (ISSN-L)
- 1468-201X
- OpenAlex
- W2053064155
- Cited by
- 183
- References
- 28
- Citations by year
- 2026: 5 · 2025: 2 · 2024: 5 · 2023: 7 · 2022: 5 · 2021: 7 · 2020: 10 · 2019: 13 · 2018: 11 · 2017: 17 · 2016: 12 · 2015: 14 · 2014: 37 · 2013: 24 · 2012: 11
- FWCI
- 16.00
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Heart (publishedVersion)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Funders
- British Heart Foundation (PG/08/130)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Clinical Neurology › Acute Ischemic Stroke Management
- Keywords
- atrial fibrillation, catheter ablation, sinus rhythm restoration, stroke prevention, mortality, antiarrhythmic drugs, paroxysmal atrial fibrillation, persistent atrial fibrillation, CHADS2 score, long-term outcomes
- MeSH terms
- Administration, Oral, Aged, Anticoagulants, Atrial Fibrillation, Female, Hemorrhage, Humans, Male, Middle Aged, Risk Factors, Case-Control Studies, Treatment Outcome, Catheter Ablation, Stroke, Kaplan-Meier Estimate
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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