Long-term risk of stroke and bleeding post atrial fibrillation ablation
Joza J, Samuel M, Jackevicius CA, Behlouli H, Jia J, Koh M, Tsadok MA, Tang ASL, Verma A, Pilote L, Essebag V. J Cardiovasc Electrophysiol. 2018; 29(10):1355-62. Epub 2018 Jul 26.
Background — Catheter ablation (CA) is an established therapy for atrial fibrillation (AF). Studies regarding long-term real-world outcomes post-CA have inconsistently accounted for oral anticoagulation (OAC).
Objectives — To describe patterns of OAC use post-CA and to compare the OAC-adjusted long-term risk of stroke and major bleeding in AF patients with and without CA.
Methods — A population-based cohort of AF patients was constructed in Quebec and Ontario, Canada (1999-2014). Propensity score-matching was performed to determine the incidence rates of stroke and major bleeding among those undergoing CA, adjusted for time-dependent OAC use.
Results — From the entire cohort, 6,391 patients were identified as having undergone CA as compared to 482,977 patients who did not. Of these, 1,240 patients with government medication insurance undergoing CA were matched to 2,427 patients without CA. Post-CA, 78%, 65% and 61% remained on an OAC at 1, 2 and 5 years, while 75%, 71%, and 68% of patients not undergoing CA were on OACs at 1, 2 and 5 years. At follow-up, there was no statistically significant difference for stroke, adjusted HR 0.88 (95% CI 0.63-1.21) or major bleeding, adjusted HR 0.88 (95% CI 0.73-1.06).
Conclusions — No evidence was found that CA significantly decreases the risk of stroke or major bleeding when adjusting for OAC use over time. It may be prudent to continue anticoagulation post CA based on patient risk profile until randomized trials demonstrate both reduced stroke rates with CA, and improved safety (balancing stroke and bleeding risk) with OAC discontinuation post-CA. This article is protected by copyright. All rights reserved.