Background Recent randomised clinical trials have suggested prognostic benefits of catheter ablation in highly selected patients with atrial fibrillation (AF) and heart failure (HF).
Objectives This study sought to identify the treatment effect associated with catheter ablation in a broad population of patients with AF and HF.
Methods Through nationwide administrative registers in Denmark, we estimated the 2-year average treatment effect (ATE) of catheter ablation for AF on a composite endpoint of HF readmission, stroke and all-cause mortality at 1-year and 5-year landmark analyses. The primary cohort was patients with AF before HF, and the second cohort of patients with HF before AF.
Results A total of 13 756 patients were included with 9904 patients in the primary cohort, and 3852 in the secondary. An ATE (95% CI) reduction of the composite endpoint of 7.0% (4.5% to 9.5%) was observed in the primary cohort and 11.8% (6.0% to 17.6%) in the secondary in the 1-year landmark analysis with a reduction in all-cause mortality of 5.8% (3.7%–7.8%) and 6.3% (0.9%–11.7%), respectively. At the 5-year landmark, catheter ablation was associated with reductions in the composite endpoint and all-cause mortality in the primary (4.7% (2.3% to 7.2%), and 3.6% (1.0% to 6.3%), respectively), but not in the secondary cohort.
Conclusions Ablation was associated with decreased risk of HF readmission, stroke and all-cause mortality in patients with AF and HF. The effect is most substantial in patients with AF before HF and with catheter ablation after 1 year from the diagnosis of both conditions.
- atrial fibrillation
- radiofrequency ablation
- heart failure
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Contributors JLP and MS helped in planning, conduction, reporting and were guarantors of the study. TAG and AM helped in planning and conduction. Reviewing was done by MLH, A-MS, AJ, FG, GHG, CT-P, PKJ, SLK and LK.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests FG is an advisor for Abbott, Carmat; Corvia (unpaid) speaker: Novartis, Astra, Orion Pharma; and investigator for Alnylam.
Patient consent for publication Not required.
Ethics approval In Denmark, retrospective register studies do not require approval from the ethics committees. The Danish Data Protection Agency approved this study (ref. no.: 2007-58-0015/GEH-2014-016 I-Suite no.: 02734), and data were made available in an anonymised format such that specific individuals could not be identified.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data may be obtained from a third party and are not publicly available.
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