title: Catheter ablation of atrial fibrillation is associated with reduced risk of stroke and mortality: A propensity score-matched analysis.
abstract: Catheter ablation reduces recurrence of atrial fibrillation and improves quality of life. Only few studies have assessed the effect of catheter ablation on long-term outcomes.
  
  
  
  The purpose of this study was to assess the association between catheter ablation and risk of stroke and mortality in patients with atrial fibrillation.
  
  
  
  Using the computerized database of the largest health maintenance organization in Israel, we identified all adults hospitalized with a primary diagnosis of atrial fibrillation between January 1, 2005, and December 31, 2015. Of them, a total of 969 individuals who underwent catheter ablation during the same admission were matched, on the basis of the propensity of having ablation, with 3772 individuals who did not undergo catheter ablation during the same period. The cohort was followed for the occurrence of stroke or transient ischemic attack (TIA) and mortality until June 30, 2016.
  
  
  
  Overall, 3953 (83.4%) of patient in both groups had a CHA2DS2VASc score of 2 or greater. The incidence rate of stroke/TIA was 2.10 and 3.26 per 100 person-years in the ablation group and the nonablation group, respectively. The crude hazard ratio [HR] for stroke/TIA was 0.61 (95% confidence interval [CI] 0.48-0.79) in the ablation group compared with the nonablation group. The results were similar after controlling for CHA2DS2-VASc score (HR 0.58; 95% CI 0.43-0.72). The adjusted HRs for stroke alone, TIA alone, and mortality were 0.62 (95% CI 0.47-0.82), 0.47 (95% CI 0.20-0.78), and 0.57 (95% CI 0.47-0.66), respectively.
  
  
  
  Catheter ablation of atrial fibrillation is associated with a decreased risk of stroke/TIA and mortality in predominantly patients with a high CHA2DS2-VASc score.
authors.affiliation: Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Clalit Health Services, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel. Electronic address: saliba_wa@clalit.org.il.
authors.forename: Walid
authors.initials: W
authors.lastname: Saliba
authors.affiliation: Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, Clalit Health Services, Haifa, Israel.
authors.forename: Jorge E
authors.initials: JE
authors.lastname: Schliamser
authors.affiliation: Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Clalit Health Services, Haifa, Israel; Statistical Unit, Lady Davis Carmel Medical Center, Clalit Health Services, Haifa, Israel.
authors.forename: Idit
authors.initials: I
authors.lastname: Lavi
authors.affiliation: Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Clalit Health Services, Haifa, Israel; Statistical Unit, Lady Davis Carmel Medical Center, Clalit Health Services, Haifa, Israel.
authors.forename: Ofra
authors.initials: O
authors.lastname: Barnett-Griness
authors.affiliation: Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Clalit Health Services, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
authors.forename: Naomi
authors.initials: N
authors.lastname: Gronich
authors.affiliation: Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Clalit Health Services, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel; Department of Epidemiology and Disease Prevention, Office of the Chief Physician, Clalit Health Services Headquarters, Tel Aviv, Israel.
authors.forename: Gad
authors.initials: G
authors.lastname: Rennert
mesh_terms: D001281:Atrial Fibrillation / Q000150:complications / Q000401:mortality / Q000601:surgery*; D017115:Catheter Ablation; D016208:Databases, Factual; D006801:Humans; D002546:Ischemic Attack, Transient / Q000209:etiology / Q000517:prevention & control; D057216:Propensity Score; D011788:Quality of Life; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D055502:Secondary Prevention; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*
keywords: Atrial fibrillation; Catheter ablation; Mortality; Stroke; TIA; Transient ischemic attack