title: Catheter Ablation of Atrial Fibrillation in U.S. Community Practice--Results From Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF).
abstract: BACKGROUND
  The characteristics of patients undergoing atrial fibrillation (AF) ablation and subsequent outcomes in community practice are not well described.
  
  
  RESULTS
  Using the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF), we investigated the prevalence and impact of catheter ablation of AF. Among 9935 patients enrolled, 5.3% had previous AF ablation. Patients with AF ablation were significantly younger, more frequently male, and had less anemia, chronic obstructive pulmonary disease, and previous myocardial infarction (P<0.05 for all analyses) than those without previous catheter ablation of AF. Ablated patients were more likely to have a family history of AF, obstructive sleep apnea, paroxysmal AF, and moderate-to-severe symptoms (P<0.0001 for all analyses). Patients with previous ablation were more often in sinus rhythm on entry into the registry (52% vs. 32%; P<0.0001). Despite previous ablation, 46% in the ablation group were still on antiarrhythmic therapy. Oral anticoagulation was prescribed in 75% of those with previous ablation versus 76% in those without previous ablation (P=0.5). The adjusted risk of death (hazard ratio [HR], 0.78; 95% confidence interval [CI], 0.52 to 1.18; P=0.2) and cardiovascular (CV) hospitalization (HR, 1.06; 95% CI, 0.90 to 1.26; P=0.5) were similar in both groups. Patients with incident AF ablation had higher risk of subsequent CV hospitalization than matched patients without incident ablation (HR, 1.67; 95% CI, 1.24 to 2.26; P=0.0008).
  
  
  CONCLUSIONS
  In U.S. clinical practice, a minority of patients with AF are managed with catheter ablation. Subsequent to ablation, there were no significant differences in oral anticoagulation use or outcomes, including stroke/non-central nervous system embolism/transient ischemic attack or death.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT01165710.
authors.affiliation: Duke Clinical Research Institute, Durham, NC (F.H., D.J.S., B.A.S., S.J.H., E.D.P., J.P.P.).
authors.forename: Fredrik
authors.initials: F
authors.lastname: Holmqvist
authors.affiliation: Duke Clinical Research Institute, Durham, NC (F.H., D.J.S., B.A.S., S.J.H., E.D.P., J.P.P.).
authors.forename: DaJuanicia
authors.initials: D
authors.lastname: Simon
authors.affiliation: Duke Clinical Research Institute, Durham, NC (F.H., D.J.S., B.A.S., S.J.H., E.D.P., J.P.P.).
authors.forename: Benjamin A
authors.initials: BA
authors.lastname: Steinberg
authors.affiliation: Duke Clinical Research Institute, Durham, NC (F.H., D.J.S., B.A.S., S.J.H., E.D.P., J.P.P.).
authors.forename: Seok Jae
authors.initials: SJ
authors.lastname: Hong
authors.affiliation: Lankenau Hospital and Medical Research Center, Philadelphia, PA (P.R.K.).
authors.forename: Peter R
authors.initials: PR
authors.lastname: Kowey
authors.affiliation: Columbia University, New York, NY (J.A.R.).
authors.forename: James A
authors.initials: JA
authors.lastname: Reiffel
authors.affiliation: Penn State Milton S. Hershey Medical Center, Hershey, PA (G.V.N.).
authors.forename: Gerald V
authors.initials: GV
authors.lastname: Naccarelli
authors.affiliation: Janssen Pharmaceuticals, Inc, Raritan, NJ (P.C.).
authors.forename: Paul
authors.initials: P
authors.lastname: Chang
authors.affiliation: Mayo Clinic College of Medicine, Rochester, MN (B.J.G.).
authors.forename: Bernard J
authors.initials: BJ
authors.lastname: Gersh
authors.affiliation: Duke Clinical Research Institute, Durham, NC (F.H., D.J.S., B.A.S., S.J.H., E.D.P., J.P.P.).
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.affiliation: Duke Clinical Research Institute, Durham, NC (F.H., D.J.S., B.A.S., S.J.H., E.D.P., J.P.P.).
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Piccini
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006764:Hospitals, Community; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries / Q000706:statistics & numerical data; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D000925:Anticoagulants
keywords: anticoagulants; atrial fibrillation; catheter ablation; morbidity; survival