Risk of stroke after catheter ablation versus cardioversion for atrial fibrillation: A propensity-matched study of 24,244 patients
Risk of stroke after catheter ablation versus cardioversion for atrial fibrillation: A propensity-matched study of 24,244 patients
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DOI：
10.1016/j.hrthm.2015.02.020
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发表时间：
2015-06-01
期刊：
影响因子：
5.5
通讯作者：
Packer, Douglas L.
中科院分区：
文献类型：
--
作者：
Noseworthy, Peter A.;Kapa, Suraj;Packer, Douglas L.
背景中风是与心房颤动（AF）相关的发病率和死亡率的主要原因。房颤导管消融术可有效降低房颤负担，但其对长期卒中风险的影响尚不清楚。目的：我们试图评估房颤导管消融术或心脏复律后的围手术期和长期卒中风险。方法：这项回顾性、倾向匹配研究使用国家行政索赔数据库，确定接受导管消融术的房颤患者和对照组（年龄、性别、治疗年份、CHA 2DS 2-Vasc评分和Chaffson指数匹配）。主要终点为（1）至首次缺血性或出血性卒中或短暂性脑缺血发作（TIA）的时间和（2）至首次缺血性或出血性卒中（不包括TIA）的时间。我们比较了围手术期卒中事件（消融术或心脏复律后30天内）以及两组之间的总卒中数。结果共有24，244例患者（12，122例接受消融术和12，122例接受心脏复律）纳入分析。消融组和心脏复律组的围手术期卒中或TIA发生率分别为0.5%和0.3%（P = 0.04）。在前30天内进行消融术有显著的卒中/TIA初始风险（率比1.53; P = 0.05）。30天后，消融组的风险显著降低（率比0.78; P = 0.03）。结论在房颤患者中，与心脏复律相比，消融术的围手术期卒中风险较小。然而，在长期随访中，消融术与卒中发生率略低相关。
BACKGROUND Stroke is the major cause of morbidity and mortality related to atrial fibrillation (AF). Catheter ablation for AF is effective in redudng AF burden, but its impact on long-term stroke risk is unknown.OBJECTIVE We sought to evaluate the periproceduraL and longterm stroke risk after catheter ablation or cardioversion for AF.METHODS This retrospective, propensity-matched study using a national administrative claims database identified patients with AF who underwent catheter ablation and a comparison group (matched on age, sex, year of treatment, CHA2DS2-Vasc score, and Chaffson index) who underwent cardioversion between 2005 and 2012. The primary end points were (1) time to first ischemic or hemorrhagic stroke or transient ischemic attack (TIA) and (2) time to first ischemic or hemorrhagic stroke excluding TIA. We compared periproceduraL incident stroke (within 30 days of ablation or cardioversion) as well as total strokes between the 2 groups.RESULTS A total of 24,244 patients (12,122 patients undergoing ablation and 12,122 patients undergoing cardioversion) were included in the analysis. Incident periproceduraL stroke or TIA occurred in 0.5% of the ablation group and 0.3% of the cardioversion group (P =.04). There was a significant initial risk of stroke/TIA with ablation within the first 30 days (rate ratio 1.53; P =.05). After 30 days, this risk was significantly lower in the ablation group (rate ratio 0.78; P =.03).CONCLUSION In patients with AF, there is a small periprocedural stroke risk with ablation in comparison to cardioversion. However, over Longer-term follow-up, ablation is associated with a slightly Lower rate of stroke.