title: Catheter ablation for atrial fibrillation is associated with lower incidence of stroke and death: data from Swedish health registries.
abstract: It is unclear if catheter ablation for atrial fibrillation (AF) affects the prognosis or merely is a symptomatic treatment. The aim is to study the association between ablation for AF, ischaemic stroke, and mortality.
  
  
  
  We identified all 361 913 patients with a diagnosis of AF in the Swedish Patient Register. During a 7-year period, 5176 AF ablations were performed among 4278 individuals. Patients who had undergone catheter ablation were younger (58.7 vs. 74.7 years, P < 0.001) and healthier (mean CHA2DS2-VASc scores 1.5 ± 1.4 vs. 3.6 ± 1.9, P < 0.001) than other patients with AF. Propensity score matching was used to construct two cohorts of equal size (n = 2836) with similar characteristics in 51 dimensions. Mean follow-up was 4.4 ± 2.0 years (minimum 1 year). In the ablated group, 78 patients suffered ischaemic stroke compared with 112 in the non-ablated (annual rates 0.70 vs. 1.0%, P = 0.013). A total of 88 ablated and 184 non-ablated patients died (annual rates 0.77 vs. 1.62%, P < 0.001). After multivariable adjustments, catheter ablation was associated with lower risk of ischaemic stroke [hazard ratio (HR) 0.69, 95% confidence interval (CI) 0.51-0.93) and with lower mortality risk (HR 0.50, 95% CI 0.37-0.62). Stroke reduction was most pronounced among patients with CHA2DS2-VASc score ≥2 (HR 0.39, 95% CI 0.19-0.78) and among patients without new cardioversions beyond 6 months after the ablation (HR 0.68, 95% CI 0.48-0.97).
  
  
  
  Ablation may be associated with lower incidence of ischaemic stroke and death in patients with AF. This beneficial finding appears more pronounced in patients with higher thromboembolic risk.
authors.affiliation: Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden Department of Cardiology, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden leif.friberg@ki.se.
authors.forename: Leif
authors.initials: L
authors.lastname: Friberg
authors.affiliation: Department of Clinical Sciences, South Hospital, Karolinska Institute, Stockholm, Sweden Arrhythmia Center Stockholm, Stockholm, Sweden.
authors.forename: Fariborz
authors.initials: F
authors.lastname: Tabrizi
authors.affiliation: Department of Clinical Sciences, South Hospital, Karolinska Institute, Stockholm, Sweden Arrhythmia Center Stockholm, Stockholm, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Englund
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation; D017115:Catheter Ablation; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D012042:Registries; D018570:Risk Assessment; D020521:Stroke; D013548:Sweden
keywords: Atrial fibrillation; Catheter ablation; Mortality; Stroke; Thromboembolism