Australian study confirms long term safety and benefits of AF catheter ablation

An Australian study of long term outcomes among patients undergoing catheter ablation for atrial fibrillation has shown a good prognosis, with half the patients not requiring re-hospitalisation for cardiac complications a decade after their procedure.

The analysis of Australian and New Zealand nation-wide hospitalisation data found 49% of the 30,601 patients were admitted to hospital again in the ten years after ablation for atrial fibrillation or a flutter, while about one in four had repeat ablation (28%) and cardioversion (24.4%).

Further, there was a survival benefit for atrial fibrillation patients with heart failure who had ablation instead of medication.

Overall, researchers considered patients who underwent atrial fibrillation ablation had good long-term clinical outcomes with a high survival probability and low rate of clinical outcomes.

Lead researcher, Dr Linh Ngo from The University of Queensland Northside Clinical Unit, said the study revealed “an encouraging long-term prognosis for these patients”.

“The findings of our study will facilitate a better-informed discussion between physician and patient undergoing [atrial fibrillation] ablation about what the patient could expect from the procedure in the long-term,” Dr Ngo said.

“The residual burden of AF, however, could be further reduced by additional measures such as weight loss, alcohol abstinence, and better management of comorbidities. This is in line with treatment guidelines which recommend an integrated and structured care for atrial fibrillation patients.”

Atrial fibrillation is a very common condition in Australia, with almost one in four men and one in five women over the age of 40 years experiencing the heart rhythm disorder.

In the study, the mean age of patients was 62.7 years and almost half (49.1%) had been hospitalised for atrial fibrillation or flutter in the previous year.

Overall, there was a survival rate of 98.8% within one year,  93% by five years and 84% by 10 years.

Likewise, a total of 11,114 patients had a planned or acute admission for atrial fibrillation during the study period. This was highest in the first year (29%), but fell to 7.8% and 3.9% at five and 10 years respectively. The cumulative rate was 23.8%.

Within the study period 6001 patients had to have repeat atrial fibrillation procedures, and 4811 had cardioversion. Again, this was highest in the first year after surgery (12.2%), and it decreased to 1.7% in the five to 10 years after the initial ablation.

About one in four people have the procedures overall (28.1%).

Further, the incidence of hospital admissions for cardiovascular events in the decade following atrial fibrillation ablation was considered “low”.

Stroke or TIAs occurred at a rate of 0.7% per year (for a cumulative incidence of 6.6%). Heart failure and heart attack had an incidence of 8.5% and 3.7%.

The cumulative incidence of re-hospitalisation for cardiovascular events was higher for people living with heart failure (cumulative incidence 17.6% – 22.0%) compared with those without (13.0% to 14.8%).

Dr Ngo said the study pointed to a potential underutilisation of ablation for people with heart failure.

“Our study found that patients with co-morbid heart failure had similar likelihood of undergoing repeat AF ablation (after adjustment for other differences) despite a worse survival compared with those without heart failure,” Dr Ngo said. “This suggests that AF ablation may be under-utilised in a group of patients that may benefit the most from this procedure.”

The findings are published in European Heart Journal – Quality of Care and Clinical Outcomes.

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