Mortality and cerebrovascular events after radiofrequency catheter ablation of atrial fibrillation

BACKGROUND Atrial fibrillation (AF) is associated with a significant increase in the risk of stroke and mortality. It is unclear whether maintaining sinus rhythm (SR) after radiofrequency ablation (RFA) is associated with an improvement in stroke risk and survival. OBJECTIVE The purpose of this study was to determine whether SR after RFA of AF is associated with an improvement in the risk of cerebrovascular events (CVEs) and mortality during an extended 10-year follow-up. METHODS RFA was performed in 3058 patients (age 58 +/- 10 years) with paroxysmal (n = 1888) or persistent AF (n = 1170). The effects of time-dependent rhythm status on CVEs and cardiac and all-cause mortality were assessed using multivariable Cox models adjusted for baseline and time-dependent variables during 11,347 patient-years of follow-up. RESULTS Independent predictors of a higher arrhythmia burden after RFA were age (estimated beta coefficient [beta] = 0.017 per 10 years, 95% confidence interval [CI] 0.006-0.029, P = .003), left atrial (LA) diameter (beta = 0.044 per 5-mm increase in LA diameter, 95% CI 0.034-0.055, P < .0001), and persistent AF (beta = 0.174, 95% CI 0.147-0.201, P < .0001). CVEs and cardiac and all-cause mortality occurred in 71 (2.3%), 33 (1.1%), and 111 (3.6%), respectively. SR after RFA was associated with a significantly lower risk of cardiac mortality (hazard ratio [HR] 0.41, 95% CI 0.20-0.84, P = .015). There was not a significant reduction in all-cause mortality (HR 0.86, 95% CI 0.58-1.29, P = .48) or CVEs (HR 0.79, 95% CI 0.48-1.29, P = .34) in patients who remained in SR after RFA. CONCLUSION Maintenance of SR after RFA is associated with a reduction in cardiovascular mortality in patients with AF.