Risk of stroke after catheter ablation versus cardioversion for atrial fibrillation: A propensity-matched study of 24,244 patients

Peter Noseworthy, Suraj Kapa, Abhishek J. Deshmukh, Malini Madhavan, Holly Van Houten, Lindsey R. Haas, Siva Mulpuru, Christopher J. McLeod, Samuel J Asirvatham, Paul Andrew Friedman, Nilay D Shah, Douglas L Packer

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

Background Stroke is the major cause of morbidity and mortality related to atrial fibrillation (AF). Catheter ablation for AF is effective in reducing AF burden, but its impact on long-term stroke risk is unknown. Objective We sought to evaluate the periprocedural and long-term stroke risk after catheter ablation or cardioversion for AF. Methods This retrospective, propensity-matched study using a national administrative claims database identified patients with AF who underwent catheter ablation and a comparison group (matched on age, sex, year of treatment, CHA<inf>2</inf>DS<inf>2</inf>-Vasc score, and Charlson index) who underwent cardioversion between 2005 and 2012. The primary end points were (1) time to first ischemic or hemorrhagic stroke or transient ischemic attack (TIA) and (2) time to first ischemic or hemorrhagic stroke excluding TIA. We compared periprocedural incident stroke (within 30 days of ablation or cardioversion) as well as total strokes between the 2 groups. Results A total of 24,244 patients (12,122 patients undergoing ablation and 12,122 patients undergoing cardioversion) were included in the analysis. Incident periprocedural stroke or TIA occurred in 0.5% of the ablation group and 0.3% of the cardioversion group (P =.04). There was a significant initial risk of stroke/TIA with ablation within the first 30 days (rate ratio 1.53; P =.05). After 30 days, this risk was significantly lower in the ablation group (rate ratio 0.78; P =.03). Conclusion In patients with AF, there is a small periprocedural stroke risk with ablation in comparison to cardioversion. However, over longer-term follow-up, ablation is associated with a slightly lower rate of stroke.

Original languageEnglish (US)
Pages (from-to)1154-1161
Number of pages8
JournalHeart Rhythm
Volume12
Issue number6
DOIs
StatePublished - Jun 1 2015

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Electric Countershock
Catheter Ablation
Atrial Fibrillation
Stroke
Transient Ischemic Attack
Research Design
Databases

Keywords

  • Ablation
  • Atrial fibrillation
  • Cardioversion
  • Stroke
  • TIA

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Risk of stroke after catheter ablation versus cardioversion for atrial fibrillation : A propensity-matched study of 24,244 patients. / Noseworthy, Peter; Kapa, Suraj; Deshmukh, Abhishek J.; Madhavan, Malini; Van Houten, Holly; Haas, Lindsey R.; Mulpuru, Siva; McLeod, Christopher J.; Asirvatham, Samuel J; Friedman, Paul Andrew; Shah, Nilay D; Packer, Douglas L.

In: Heart Rhythm, Vol. 12, No. 6, 01.06.2015, p. 1154-1161.

Research output: Contribution to journalArticle

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title = "Risk of stroke after catheter ablation versus cardioversion for atrial fibrillation: A propensity-matched study of 24,244 patients",
abstract = "Background Stroke is the major cause of morbidity and mortality related to atrial fibrillation (AF). Catheter ablation for AF is effective in reducing AF burden, but its impact on long-term stroke risk is unknown. Objective We sought to evaluate the periprocedural and long-term stroke risk after catheter ablation or cardioversion for AF. Methods This retrospective, propensity-matched study using a national administrative claims database identified patients with AF who underwent catheter ablation and a comparison group (matched on age, sex, year of treatment, CHA2DS2-Vasc score, and Charlson index) who underwent cardioversion between 2005 and 2012. The primary end points were (1) time to first ischemic or hemorrhagic stroke or transient ischemic attack (TIA) and (2) time to first ischemic or hemorrhagic stroke excluding TIA. We compared periprocedural incident stroke (within 30 days of ablation or cardioversion) as well as total strokes between the 2 groups. Results A total of 24,244 patients (12,122 patients undergoing ablation and 12,122 patients undergoing cardioversion) were included in the analysis. Incident periprocedural stroke or TIA occurred in 0.5{\%} of the ablation group and 0.3{\%} of the cardioversion group (P =.04). There was a significant initial risk of stroke/TIA with ablation within the first 30 days (rate ratio 1.53; P =.05). After 30 days, this risk was significantly lower in the ablation group (rate ratio 0.78; P =.03). Conclusion In patients with AF, there is a small periprocedural stroke risk with ablation in comparison to cardioversion. However, over longer-term follow-up, ablation is associated with a slightly lower rate of stroke.",
keywords = "Ablation, Atrial fibrillation, Cardioversion, Stroke, TIA",
author = "Peter Noseworthy and Suraj Kapa and Deshmukh, {Abhishek J.} and Malini Madhavan and {Van Houten}, Holly and Haas, {Lindsey R.} and Siva Mulpuru and McLeod, {Christopher J.} and Asirvatham, {Samuel J} and Friedman, {Paul Andrew} and Shah, {Nilay D} and Packer, {Douglas L}",
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T1 - Risk of stroke after catheter ablation versus cardioversion for atrial fibrillation

T2 - A propensity-matched study of 24,244 patients

AU - Noseworthy, Peter

AU - Kapa, Suraj

AU - Deshmukh, Abhishek J.

AU - Madhavan, Malini

AU - Van Houten, Holly

AU - Haas, Lindsey R.

AU - Mulpuru, Siva

AU - McLeod, Christopher J.

AU - Asirvatham, Samuel J

AU - Friedman, Paul Andrew

AU - Shah, Nilay D

AU - Packer, Douglas L

PY - 2015/6/1

Y1 - 2015/6/1

N2 - Background Stroke is the major cause of morbidity and mortality related to atrial fibrillation (AF). Catheter ablation for AF is effective in reducing AF burden, but its impact on long-term stroke risk is unknown. Objective We sought to evaluate the periprocedural and long-term stroke risk after catheter ablation or cardioversion for AF. Methods This retrospective, propensity-matched study using a national administrative claims database identified patients with AF who underwent catheter ablation and a comparison group (matched on age, sex, year of treatment, CHA2DS2-Vasc score, and Charlson index) who underwent cardioversion between 2005 and 2012. The primary end points were (1) time to first ischemic or hemorrhagic stroke or transient ischemic attack (TIA) and (2) time to first ischemic or hemorrhagic stroke excluding TIA. We compared periprocedural incident stroke (within 30 days of ablation or cardioversion) as well as total strokes between the 2 groups. Results A total of 24,244 patients (12,122 patients undergoing ablation and 12,122 patients undergoing cardioversion) were included in the analysis. Incident periprocedural stroke or TIA occurred in 0.5% of the ablation group and 0.3% of the cardioversion group (P =.04). There was a significant initial risk of stroke/TIA with ablation within the first 30 days (rate ratio 1.53; P =.05). After 30 days, this risk was significantly lower in the ablation group (rate ratio 0.78; P =.03). Conclusion In patients with AF, there is a small periprocedural stroke risk with ablation in comparison to cardioversion. However, over longer-term follow-up, ablation is associated with a slightly lower rate of stroke.

AB - Background Stroke is the major cause of morbidity and mortality related to atrial fibrillation (AF). Catheter ablation for AF is effective in reducing AF burden, but its impact on long-term stroke risk is unknown. Objective We sought to evaluate the periprocedural and long-term stroke risk after catheter ablation or cardioversion for AF. Methods This retrospective, propensity-matched study using a national administrative claims database identified patients with AF who underwent catheter ablation and a comparison group (matched on age, sex, year of treatment, CHA2DS2-Vasc score, and Charlson index) who underwent cardioversion between 2005 and 2012. The primary end points were (1) time to first ischemic or hemorrhagic stroke or transient ischemic attack (TIA) and (2) time to first ischemic or hemorrhagic stroke excluding TIA. We compared periprocedural incident stroke (within 30 days of ablation or cardioversion) as well as total strokes between the 2 groups. Results A total of 24,244 patients (12,122 patients undergoing ablation and 12,122 patients undergoing cardioversion) were included in the analysis. Incident periprocedural stroke or TIA occurred in 0.5% of the ablation group and 0.3% of the cardioversion group (P =.04). There was a significant initial risk of stroke/TIA with ablation within the first 30 days (rate ratio 1.53; P =.05). After 30 days, this risk was significantly lower in the ablation group (rate ratio 0.78; P =.03). Conclusion In patients with AF, there is a small periprocedural stroke risk with ablation in comparison to cardioversion. However, over longer-term follow-up, ablation is associated with a slightly lower rate of stroke.

KW - Ablation

KW - Atrial fibrillation

KW - Cardioversion

KW - Stroke

KW - TIA

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DO - 10.1016/j.hrthm.2015.02.020

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