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Catheter Ablation of Atrial Fibrillation in US Community Practice-Results From Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF)

Holmqvist, Fredrik; Simon, DaJuanicia; Steinberg, Benjamin A.; Hong, Seok Jae; Kowey, Peter R.; Reiffel, James A.; Naccarelli, Gerald V.; Chang, Paul; Gersh, Bernard J. and Peterson, Eric D., et al. (2015) In Journal of the American Heart Association 4(5). p.001901-001901
Abstract
Background-The characteristics of patients undergoing atrial fibrillation (AF) ablation and subsequent outcomes in community practice are not well described. Methods and Results-Using the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF), we investigated the prevalence and impact of catheter ablation of AF. Among 9935 patients enrolled, 5.3% had previous AF ablation. Patients with AF ablation were significantly younger, more frequently male, and had less anemia, chronic obstructive pulmonary disease, and previous myocardial infarction (P<0.05 for all analyses) than those without previous catheter ablation of AF. Ablated patients were more likely to have a family history of AF, obstructive sleep apnea,... (More)
Background-The characteristics of patients undergoing atrial fibrillation (AF) ablation and subsequent outcomes in community practice are not well described. Methods and Results-Using the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF), we investigated the prevalence and impact of catheter ablation of AF. Among 9935 patients enrolled, 5.3% had previous AF ablation. Patients with AF ablation were significantly younger, more frequently male, and had less anemia, chronic obstructive pulmonary disease, and previous myocardial infarction (P<0.05 for all analyses) than those without previous catheter ablation of AF. Ablated patients were more likely to have a family history of AF, obstructive sleep apnea, paroxysmal AF, and moderate-to-severe symptoms (P<0.0001 for all analyses). Patients with previous ablation were more often in sinus rhythm on entry into the registry (52% vs. 32%; P<0.0001). Despite previous ablation, 46% in the ablation group were still on antiarrhythmic therapy. Oral anticoagulation was prescribed in 75% of those with previous ablation versus 76% in those without previous ablation (P=0.5). The adjusted risk of death (hazard ratio [HR], 0.78; 95% confidence interval [CI], 0.52 to 1.18; P=0.2) and cardiovascular (CV) hospitalization (HR, 1.06; 95% CI, 0.90 to 1.26; P=0.5) were similar in both groups. Patients with incident AF ablation had higher risk of subsequent CV hospitalization than matched patients without incident ablation (HR, 1.67; 95% CI, 1.24 to 2.26; P=0.0008). Conclusions-In U.S. clinical practice, a minority of patients with AF are managed with catheter ablation. Subsequent to ablation, there were no significant differences in oral anticoagulation use or outcomes, including stroke/non-central nervous system embolism/transient ischemic attack or death. (Less)
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type
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publication status
published
subject
keywords
anticoagulants, atrial fibrillation, catheter ablation, morbidity, survival
in
Journal of the American Heart Association
volume
4
issue
5
pages
001901 - 001901
publisher
Wiley-Blackwell
external identifiers
  • wos:000356347600017
  • scopus:85016650450
ISSN
2047-9980
DOI
10.1161/JAHA.115.001901
language
English
LU publication?
no
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8576ef16-cede-4179-bdd6-b4c7559a47f0 (old id 7790927)
date added to LUP
2015-09-01 16:09:34
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2017-10-01 04:28:06
@article{8576ef16-cede-4179-bdd6-b4c7559a47f0,
  abstract     = {Background-The characteristics of patients undergoing atrial fibrillation (AF) ablation and subsequent outcomes in community practice are not well described. Methods and Results-Using the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF), we investigated the prevalence and impact of catheter ablation of AF. Among 9935 patients enrolled, 5.3% had previous AF ablation. Patients with AF ablation were significantly younger, more frequently male, and had less anemia, chronic obstructive pulmonary disease, and previous myocardial infarction (P&lt;0.05 for all analyses) than those without previous catheter ablation of AF. Ablated patients were more likely to have a family history of AF, obstructive sleep apnea, paroxysmal AF, and moderate-to-severe symptoms (P&lt;0.0001 for all analyses). Patients with previous ablation were more often in sinus rhythm on entry into the registry (52% vs. 32%; P&lt;0.0001). Despite previous ablation, 46% in the ablation group were still on antiarrhythmic therapy. Oral anticoagulation was prescribed in 75% of those with previous ablation versus 76% in those without previous ablation (P=0.5). The adjusted risk of death (hazard ratio [HR], 0.78; 95% confidence interval [CI], 0.52 to 1.18; P=0.2) and cardiovascular (CV) hospitalization (HR, 1.06; 95% CI, 0.90 to 1.26; P=0.5) were similar in both groups. Patients with incident AF ablation had higher risk of subsequent CV hospitalization than matched patients without incident ablation (HR, 1.67; 95% CI, 1.24 to 2.26; P=0.0008). Conclusions-In U.S. clinical practice, a minority of patients with AF are managed with catheter ablation. Subsequent to ablation, there were no significant differences in oral anticoagulation use or outcomes, including stroke/non-central nervous system embolism/transient ischemic attack or death.},
  author       = {Holmqvist, Fredrik and Simon, DaJuanicia and Steinberg, Benjamin A. and Hong, Seok Jae and Kowey, Peter R. and Reiffel, James A. and Naccarelli, Gerald V. and Chang, Paul and Gersh, Bernard J. and Peterson, Eric D. and Piccini, Jonathan P.},
  issn         = {2047-9980},
  keyword      = {anticoagulants,atrial fibrillation,catheter ablation,morbidity,survival},
  language     = {eng},
  number       = {5},
  pages        = {001901--001901},
  publisher    = {Wiley-Blackwell},
  series       = {Journal of the American Heart Association},
  title        = {Catheter Ablation of Atrial Fibrillation in US Community Practice-Results From Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF)},
  url          = {http://dx.doi.org/10.1161/JAHA.115.001901},
  volume       = {4},
  year         = {2015},
}