Catheter Ablation of Atrial Fibrillation in U.S. Community Practice--Results From Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF).
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, 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. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov.
Unique identifier: NCT01165710.
Type
Journal articleSubject
anticoagulantsatrial fibrillation
catheter ablation
morbidity
survival
Aged
Anticoagulants
Atrial Fibrillation
Catheter Ablation
Female
Hospitalization
Hospitals, Community
Humans
Male
Middle Aged
Registries
Risk Factors
Treatment Outcome
United States
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https://hdl.handle.net/10161/14999Published Version (Please cite this version)
10.1161/JAHA.115.001901Publication Info
Holmqvist, Fredrik; Simon, DaJuanicia; Steinberg, Benjamin A; Hong, Seok Jae; Kowey,
Peter R; Reiffel, James A; ... ORBIT‐AF Investigators (2015). Catheter Ablation of Atrial Fibrillation in U.S. Community Practice--Results From
Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF).
J Am Heart Assoc, 4(5). 10.1161/JAHA.115.001901. Retrieved from https://hdl.handle.net/10161/14999.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Eric David Peterson
Fred Cobb, M.D. Distinguished Professor of Medicine
Dr Peterson is the Fred Cobb Distinguished Professor of Medicine in the Division of
Cardiology, a DukeMed Scholar, and the Past Executive Director of the Duke Clinical
Research Institute (DCRI), Durham, NC, USA.
Dr Peterson is the Principal Investigator of the National Institute of Health, Lung
and Blood Institute (NHLBI) Spironolactone Initiation Registry Randomized Interventional
Trial in Heart Failure With Preserved Ejection Fraction (SPIRRIT) Trial He is also
the Principal I
This author no longer has a Scholars@Duke profile, so the information shown here reflects
their Duke status at the time this item was deposited.
Jonathan Paul Piccini Sr.
Associate Professor of Medicine
Jonathan P. Piccini, MD, MHS, FACC, FAHA, FHRS is a clinical cardiac electrophysiologist
and Associate Professor of Medicine with Tenure at Duke University Medical Center
and the Duke Clinical Research Institute. He is the Director of the Cardiac Electrophysiology
section at the Duke Heart Center. His focus is on the care of patients with atrial
fibrillation and complex arrhythmias, with particular emphasis on catheter ablation,
left atrial appendage occlusion, and lead extraction. His resear
Benjamin Steinberg
House Staff
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