Association of pulmonary vein isolation and major cardiovascular events in patients with atrial fibrillation

Abstract

Background: Patients with atrial fibrillation (AF) face an increased risk of adverse cardiovascular events. Evidence suggests that early rhythm control including AF ablation may reduce this risk.

Methods: To compare the risks for cardiovascular events in AF patients with and without pulmonary vein isolation (PVI), we analysed data from two prospective cohort studies in Switzerland (n = 3968). A total of 325 patients who had undergone PVI during a 1-year observational period were assigned to the PVI group. Using coarsened exact matching, 2193 patients were assigned to the non-PVI group. Outcomes were all-cause mortality, hospital admission for acute heart failure, a composite of stroke, transient ischemic attack and systemic embolism (Stroke/TIA/SE), myocardial infarction (MI), and bleedings. We calculated multivariable adjusted Cox proportional-hazards models.

Results: Overall, 2518 patients were included, median age was 66 years [IQR 61.0, 71.0], 25.8% were female. After a median follow-up time of 3.9 years, fewer patients in the PVI group died from any cause (incidence per 100 patient-years 0.64 versus 1.87, HR 0.39, 95%CI 0.19-0.79, p = 0.009) or were admitted to hospital for acute heart failure (incidence per 100 patient-years 0.52 versus 1.72, HR 0.44, 95%CI 0.21-0.95, p = 0.035). There was no significant association between PVI and Stroke/TIA/SE (HR 0.94, 95%CI 0.52-1.69, p = 0.80), MI (HR 0.43, 95%CI 0.11-1.63, p = 0.20) or bleeding (HR 0.75, 95% CI 0.50-1.12, p = 0.20).

Conclusions: In our matched comparison, patients in the PVI group had a lower incidence rate of all-cause mortality and hospital admission for acute heart failure compared to the non-PVI group.

Gov identifier: NCT02105844, April 7th 2014.

Keywords: Adverse outcome events; Atrial fibrillation; Coarsened exact matching; Pulmonary vein isolation.

Conflict of interest statement

D. Conen received consulting fees from Servier Canada and Roche Diagnostics. G. Moschovitis has received consultant fees for taking part to advisory boards from Novartis, Boehringer Ingelheim, Bayer and Astra Zeneca, all outside of the submitted work. M. Kühne reports personal fees from Bayer, personal fees from Böhringer Ingelheim, personal fees from Pfizer BMS, personal fees from Daiichi Sankyo, personal fees from Medtronic, personal fees from Biotronik, personal fees from Boston Scientific, personal fees from Johnson&Johnson, personal fees from Roche, grants from Bayer, grants from Pfizer, grants from Boston Scientific, grants from BMS, grants from Biotronik.

© 2022. The Author(s).

Figures

Fig. 1

Multivariable adjusted cox-proportional hazards models for adverse events in a matched population. Mortality All-cause mortality; aHF Hospital admission for acute heart failure; Stroke/TIA/SE Stroke, transient ischemic attack, and systemic embolism;  MI Myocardial infarction; Bleeding Major bleeding and clinically relevant non-major bleeding, Death/Stroke/aHF/MI Composite of death from cardiovascular causes, stroke, or hospital admission for acute heart failure or myocardial infarction. The colours represent the two different models. Model 1 was adjusted for age, within each stratum with identical values for all matching covariates. Model 2 was additionally adjusted for history of coronary artery disease and heart failure hospitalization, within each stratum with identical values for all matching covariates