Abstract 16200: Risk of Stroke After Catheter Ablation or Cardioversion for Atrial Fibrillation: Results From a Large Administrative Database, 2008-2012
Background: Stroke is the major cause of morbidity and mortality related to atrial fibrillation (AF). Catheter ablation for AF is effective in reducing AF burden, but the impact on long term stroke risk is unknown.
Methods: This retrospective, propensity-matched study using a large, national US health plan administrative claims database included AF patients who underwent a catheter ablation between 2008 and 2012 and created a comparison group (matched for age, sex, year of service, and CHADS2 score) of AF patients who were treated with cardioversion over the same time period. The primary endpoint was first ischemic or hemorrhagic stroke or TIA. We compared periprocedural incident stroke (within 30 days of ablation or cardioversion), as well as incident late stroke (31 days to end of follow up) and incident total stroke between the two groups.
Results: 14,852 patients (7,426 ablation and 7,426 cardioversion patients) were included in analysis. The mean age was 58.3 (SD 10.5) years, 70.9% were male, and 25%, 42.8%, and 32.2% had CHADS2 scores of 0, 1, or ≥ 2, respectively (no differences between ablation and cardioversion groups). Patients were followed for a mean of 2.2 ± 1.5 years. Incident periprocedural stroke occurred in 0.4% of the ablation group and 0.2% of the cardioversion group (p=0.009). Late stroke occurred in 0.55%/year in the ablation group and 0.84%/year in the cardioversion group (p=0.004). The total stroke rate was 0.75%/year in the ablation group and 0.90%/year in the cardioversion group (p=0.14).
Conclusion: Although there is an increased risk of stroke in the immediate post ablation period, late strokes are less common, and the total risk of stroke is similar in patients undergoing ablation compared to matched patients treated with cardioversion.
Author Disclosures: P.A. Noseworthy: None. S. Kapa: None. M. Madhavan: None. H. Van Houten: None. L. Haas: None. C. McLeod: None. P. Friedman: None. S. Asirvatham: Honoraria; Modest; Abiomed, Atricure, Biotronik, Biosense Webster, Boston Scientific, Medtronic, Spectranetics, St. Jude, Sanofi-Aventis, Wolters Kluwer, Elsevier. Other; Modest; Aegis, Access Point Technologies, Nevro, Sanovas, Sorin Medical. N. Shah: None. D. Packer: Research Grant; Modest; Endosense, Siemens Acuson, EP Advocate, U of Minnesota Partnership for Biotechnology and Medical Genomics, CardioFocus, Hansen Medical, Thermedical. Consultant/Advisory Board; Modest; Abiomed $0, Biosense Webster $0, Boston Scientific $0, CardioDX $0, CardioFocus $0, CardioInsight $0, InfoBionics $0, Johnson & Johnson $0, Medtronic/CryoCath $0, Sanofi-Aventis $0, Siemens $0, St. Jude Medical $0, OrthoMcNeill $0. Other; Modest; Royalty Blackwell Publishing, Oxford Publishing, Oxford Royalty. Research Grant; Significant; Biosense Webster, EpiEP, Medtronic, NIH, AHA Fellow Grant, Boston Scientific, St. Jude Medical. Other; Significant; Royalty St. Jude Medical.
- © 2014 by American Heart Association, Inc.