Journal article
Long-term risk of stroke and bleeding post-atrial fibrillation ablation
Journal of cardiovascular electrophysiology, v 29(10), pp 1355-1362
01 Oct 2018
PMID: 30047574
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
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).
ObjectivesMethodsTo 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.
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.
ResultsConclusionFrom the entire cohort, 6391 patients were identified as having undergone CA as compared to 482977 patients who did not. Of these, 1240 patients with government medical insurance undergoing CA were matched with 2427 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 hazard ratio [HR], 0.88; 95% CI, 0.63 to 1.21) or major bleeding (adjusted HR, 0.88; 95% CI, 0.73 to 1.06).
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.
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Details
- Title
- Long-term risk of stroke and bleeding post-atrial fibrillation ablation
- Creators
- Jacqueline Joza - McGill University Health CentreMichelle Samuel - McGill University Health CentreCynthia A. Jackevicius - Institute for Clinical Evaluative SciencesHassan Behlouli - McGill University Health CentreJing Jia - Institute for Clinical Evaluative SciencesMaria Koh - Institute for Clinical Evaluative SciencesMeytal Avgil Tsadok - McGill University Health CentreAnthony S. L. Tang - Western Univ, Div Cardiol, London, ON, CanadaAtul Verma - McGill University Health CentreLouise Pilote - McGill University Health CentreVidal Essebag - McGill University Health Centre
- Publication Details
- Journal of cardiovascular electrophysiology, v 29(10), pp 1355-1362
- Publisher
- Wiley
- Number of pages
- 8
- Grant note
- Fonds de recherche du Quebec-Sante (FRQS), Clinical Research Scholar Award; Fonds de recherche du Quebec (FRQ); Fonds de recherche du Quebec - Sante (FRQS) 133717 / Canadian Institutes of Health Research (CIHR)
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- General Internal Medicine
- Web of Science ID
- WOS:000448078900003
- Scopus ID
- 2-s2.0-85054780730
- Other Identifier
- 991022135715704721
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- Collaboration types
- Domestic collaboration
- International collaboration
- Web of Science research areas
- Cardiac & Cardiovascular Systems