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著者: T Jared Bunch, Heidi T May, Tami L Bair, J Peter Weiss, Brian G Crandall, Jeffrey S Osborn, Charles Mallender, Jeffrey L Anderson, Brent J Muhlestein, Donald L Lappe, John D Day
雑誌名: Heart Rhythm. 2013 Sep;10(9):1272-7. doi: 10.1016/j.hrthm.2013.07.002. Epub 2013 Jul 5.
Abstract/Text
BACKGROUND: Atrial fibrillation (AF) is a leading cause of total and fatal ischemic stroke. Stroke risk after AF ablation appears to be favorably affected; however, it is largely unknown whether the benefit extends to all stroke CHADS2 risk profiles of AF patients.
OBJECTIVE: To determine if ablation of atrial fibrillation reduces stroke rates in all risk groups.
METHODS: A total of 4212 consecutive patients who underwent AF ablation were compared (1:4) with 16,848 age-/sex-matched controls with AF (no ablation) and to 16,848 age-/sex-matched controls without AF. Patients were enrolled from the large ongoing prospective Intermountain Atrial Fibrillation Study and were followed for at least 3 years.
RESULTS: Of the 37,908 patients, the mean age was 65.0 ± 13 years and 4.4% (no AF), 6.3% (AF, no ablation), and 4.5% (AF ablation) patients had a prior stroke (P < .0001). The profile of CHADS2 scores between comparative groups was similar: 0-1 (69.3%, no AF; 62.3%, AF, no ablation; 63.6%, AF ablation), 2-3 (26.5%, no AF; 29.7%, AF, no ablation; 28.7%, AF ablation), and ≥4 (4.3%, no AF; 8.0%, AF, no ablation; 7.7%, AF ablation). A total of 1296 (3.4%) patients had a stroke over the follow-up period. Across all CHADS2 profiles and ages, AF patients with ablation had a lower long-term risk of stroke compared to patients without ablation. Furthermore, AF ablation patients had similar long-term risks of stroke across all CHADS2 profiles and ages compared to patients with no history of AF.
CONCLUSIONS: In our study populations, AF ablation patients have a significantly lower risk of stroke compared to AF patients who do not undergo ablation independent of baseline stroke risk score.
Copyright © 2013 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.
PMID 23835257 Heart Rhythm. 2013 Sep;10(9):1272-7. doi: 10.1016/j.hrthm.2013.07.002. Epub 2013 Jul 5.
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