Catheter Ablation of Atrial Fibrillation in U.S. 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

Peterson, Eric D

Piccini, Jonathan P

ORBIT‐AF Investigators

England

2017-07-06T14:12:46Z

2017-07-06T14:12:46Z

2015-05-21

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.

https://www.ncbi.nlm.nih.gov/pubmed/25999401

JAHA.115.001901

2047-9980

https://hdl.handle.net/10161/14999

eng

Ovid Technologies (Wolters Kluwer Health)

J Am Heart Assoc

10.1161/JAHA.115.001901

anticoagulants

atrial 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

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

Journal article

Peterson, Eric D|0000-0002-5415-4721

Piccini, Jonathan P|0000-0003-0772-2404

https://www.ncbi.nlm.nih.gov/pubmed/25999401

5

Clinical Science Departments

Duke

Duke Clinical Research Institute

Institutes and Centers

Medicine

Medicine, Cardiology

School of Medicine

Published online

4