title: 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).
  
  
  CONCLUSIONS
  Restoration of sinus rhythm by catheter ablation of AF is associated with lower rates of stroke and death compared with patients treated medically.
authors.affiliation: Cardiology Department, Barts and The London NHS Trust QMUL, St Bartholomew's Hospital, London EC1A 7BE, UK.
authors.forename: Ross J
authors.initials: RJ
authors.lastname: Hunter
authors.forename: James
authors.initials: J
authors.lastname: McCready
authors.forename: Ihab
authors.initials: I
authors.lastname: Diab
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Page
authors.forename: Malcolm
authors.initials: M
authors.lastname: Finlay
authors.forename: Laura
authors.initials: L
authors.lastname: Richmond
authors.forename: Antony
authors.initials: A
authors.lastname: French
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Earley
authors.forename: Simon
authors.initials: S
authors.lastname: Sporton
authors.forename: Michael
authors.initials: M
authors.lastname: Jones
authors.forename: Jubin P
authors.initials: JP
authors.lastname: Joseph
authors.forename: Yaver
authors.initials: Y
authors.lastname: Bashir
authors.forename: Tim R
authors.initials: TR
authors.lastname: Betts
authors.forename: Glyn
authors.initials: G
authors.lastname: Thomas
authors.forename: Andrew
authors.initials: A
authors.lastname: Staniforth
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Lee
authors.forename: Peter
authors.initials: P
authors.lastname: Kistler
authors.forename: Kim
authors.initials: K
authors.lastname: Rajappan
authors.forename: Anthony
authors.initials: A
authors.lastname: Chow
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Schilling
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D016022:Case-Control Studies; D017115:Catheter Ablation / Q000379:methods* / Q000401:mortality; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D020521:Stroke / Q000401:mortality / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants