Prognostic Implications and Efficacy of Catheter Ablation by Atrial Fibrillation Type
Background Catheter ablation (CA) for atrial fibrillation (AF) is preferred for paroxysmal AF (PAF) but selectively performed in patients with persistent AF (PersAF). This study aimed to investigate the prognostic differences and consequences of CA based on the AF type. Methods and Results Data from...
| Main Authors: | , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-09-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.122.029321 |
| _version_ | 1797632525210746880 |
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| author | Hiroshi Miyama Seiji Takatsuki Nobuhiro Ikemura Takehiro Kimura Yoshinori Katsumata Shuhei Yamashita Koki Yamaoka Susumu Ibe Yuta Seki Terumasa Yamashita Kenji Hashimoto Ikuko Ueda Koji Ueno Takahiro Ohki Keiichi Fukuda Shun Kohsaka |
| author_facet | Hiroshi Miyama Seiji Takatsuki Nobuhiro Ikemura Takehiro Kimura Yoshinori Katsumata Shuhei Yamashita Koki Yamaoka Susumu Ibe Yuta Seki Terumasa Yamashita Kenji Hashimoto Ikuko Ueda Koji Ueno Takahiro Ohki Keiichi Fukuda Shun Kohsaka |
| author_sort | Hiroshi Miyama |
| collection | DOAJ |
| description | Background Catheter ablation (CA) for atrial fibrillation (AF) is preferred for paroxysmal AF (PAF) but selectively performed in patients with persistent AF (PersAF). This study aimed to investigate the prognostic differences and consequences of CA based on the AF type. Methods and Results Data from a multicenter AF cohort study were analyzed, categorizing patients as PAF or PersAF according to AF duration (≤7 or >7 days, respectively). A composite of all‐cause death, heart failure hospitalization, stroke, and bleeding events during 2‐year follow‐up and changes in the Atrial Fibrillation Effect on Quality‐of‐life score were compared. Additionally, propensity score matching was performed to compare clinical outcomes of patients with and without CA in both AF types. Among 2788 patients, 51.6% and 48.4% had PAF and PersAF, respectively. Patients with PersAF had a higher incidence of the composite outcome (12.8% versus 7.2%; P<0.001) and smaller improvements in Atrial Fibrillation Effect on Quality‐of‐life scores than those with PAF. After adjusting for baseline characteristics, PersAF was an independent predictor of adverse outcomes (adjusted hazard ratio, 1.35 [95% CI, 1.30–1.78], P=0.031) and was associated with poor improvements in Atrial Fibrillation Effect on Quality‐of‐life scores. Propensity score matching analysis showed that the CA group had significantly fewer adverse events than the medication group among patients with PAF (odds ratio, 0.31 [95% CI, 0.18–0.68]; P=0.002). Patients with PersAF showed a similar but nonsignificant trend. Conclusions PersAF is a risk factor for worse clinical outcomes, including patients' health status. CA is associated with fewer adverse events, although careful consideration is required based on the AF type. |
| first_indexed | 2024-03-11T11:38:14Z |
| format | Article |
| id | doaj.art-129d8c34ad55490abc63cbdb251e0469 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-03-11T11:38:14Z |
| publishDate | 2023-09-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-129d8c34ad55490abc63cbdb251e04692023-11-10T10:23:42ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802023-09-01121810.1161/JAHA.122.029321Prognostic Implications and Efficacy of Catheter Ablation by Atrial Fibrillation TypeHiroshi Miyama0Seiji Takatsuki1Nobuhiro Ikemura2Takehiro Kimura3Yoshinori Katsumata4Shuhei Yamashita5Koki Yamaoka6Susumu Ibe7Yuta Seki8Terumasa Yamashita9Kenji Hashimoto10Ikuko Ueda11Koji Ueno12Takahiro Ohki13Keiichi Fukuda14Shun Kohsaka15Department of Cardiology Keio University School of Medicine Tokyo JapanDepartment of Cardiology Keio University School of Medicine Tokyo JapanDepartment of Cardiology Keio University School of Medicine Tokyo JapanDepartment of Cardiology Keio University School of Medicine Tokyo JapanDepartment of Cardiology Keio University School of Medicine Tokyo JapanDepartment of Cardiology Keio University School of Medicine Tokyo JapanDepartment of Cardiology Keio University School of Medicine Tokyo JapanDepartment of Cardiology Keio University School of Medicine Tokyo JapanDepartment of Cardiology Keio University School of Medicine Tokyo JapanDepartment of Cardiology Keio University School of Medicine Tokyo JapanDepartment of Cardiology Keio University School of Medicine Tokyo JapanDepartment of Cardiology Keio University School of Medicine Tokyo JapanDepartment of Cardiology Saiseikai Utsunomiya Hospital Tochigi JapanDepartment of Cardiology Tokyo Dental College Ichikawa General Hospital Chiba JapanDepartment of Cardiology Keio University School of Medicine Tokyo JapanDepartment of Cardiology Keio University School of Medicine Tokyo JapanBackground Catheter ablation (CA) for atrial fibrillation (AF) is preferred for paroxysmal AF (PAF) but selectively performed in patients with persistent AF (PersAF). This study aimed to investigate the prognostic differences and consequences of CA based on the AF type. Methods and Results Data from a multicenter AF cohort study were analyzed, categorizing patients as PAF or PersAF according to AF duration (≤7 or >7 days, respectively). A composite of all‐cause death, heart failure hospitalization, stroke, and bleeding events during 2‐year follow‐up and changes in the Atrial Fibrillation Effect on Quality‐of‐life score were compared. Additionally, propensity score matching was performed to compare clinical outcomes of patients with and without CA in both AF types. Among 2788 patients, 51.6% and 48.4% had PAF and PersAF, respectively. Patients with PersAF had a higher incidence of the composite outcome (12.8% versus 7.2%; P<0.001) and smaller improvements in Atrial Fibrillation Effect on Quality‐of‐life scores than those with PAF. After adjusting for baseline characteristics, PersAF was an independent predictor of adverse outcomes (adjusted hazard ratio, 1.35 [95% CI, 1.30–1.78], P=0.031) and was associated with poor improvements in Atrial Fibrillation Effect on Quality‐of‐life scores. Propensity score matching analysis showed that the CA group had significantly fewer adverse events than the medication group among patients with PAF (odds ratio, 0.31 [95% CI, 0.18–0.68]; P=0.002). Patients with PersAF showed a similar but nonsignificant trend. Conclusions PersAF is a risk factor for worse clinical outcomes, including patients' health status. CA is associated with fewer adverse events, although careful consideration is required based on the AF type.https://www.ahajournals.org/doi/10.1161/JAHA.122.029321atrial fibrillationcatheter ablationhealth‐related quality of lifeparoxysmal atrial fibrillationpersistent atrial fibrillation |
| spellingShingle | Hiroshi Miyama Seiji Takatsuki Nobuhiro Ikemura Takehiro Kimura Yoshinori Katsumata Shuhei Yamashita Koki Yamaoka Susumu Ibe Yuta Seki Terumasa Yamashita Kenji Hashimoto Ikuko Ueda Koji Ueno Takahiro Ohki Keiichi Fukuda Shun Kohsaka Prognostic Implications and Efficacy of Catheter Ablation by Atrial Fibrillation Type Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease atrial fibrillation catheter ablation health‐related quality of life paroxysmal atrial fibrillation persistent atrial fibrillation |
| title | Prognostic Implications and Efficacy of Catheter Ablation by Atrial Fibrillation Type |
| title_full | Prognostic Implications and Efficacy of Catheter Ablation by Atrial Fibrillation Type |
| title_fullStr | Prognostic Implications and Efficacy of Catheter Ablation by Atrial Fibrillation Type |
| title_full_unstemmed | Prognostic Implications and Efficacy of Catheter Ablation by Atrial Fibrillation Type |
| title_short | Prognostic Implications and Efficacy of Catheter Ablation by Atrial Fibrillation Type |
| title_sort | prognostic implications and efficacy of catheter ablation by atrial fibrillation type |
| topic | atrial fibrillation catheter ablation health‐related quality of life paroxysmal atrial fibrillation persistent atrial fibrillation |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.122.029321 |
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