Catheter ablation and risk of major adverse cardiovascular events in high-risk patients with newly diagnosed atrial fibrillation: a target trial emulation.

Abstract

Atrial fibrillation (AF) is a common cardiac arrhythmia associated with an increased risk of stroke, heart failure and mortality. While catheter ablation is increasingly used for early rhythm control, evidence on its cardiovascular outcomes in high-risk individuals with newly diagnosed AF remains limited. This study aimed to evaluate the association between catheter ablation and the risk of major adverse cardiovascular events (MACE) in high-risk patients with newly diagnosed AF using a target trial emulation design. We used the TriNetX database to identify adults with newly diagnosed AF between 1 January 2015 and 30 April 2022. Patients with prior stroke, prior cardiovascular events or valvular heart disease were excluded. Patients were assigned to ablation or non-ablation cohorts. Propensity score matching (1:1) and a landmark design with 1-year follow-up starting on Day 366 were employed. The primary outcome was MACEs. Subgroup and 2-year sensitivity analyses were performed. Among 263 329 eligible patients, 2018 (0.8%) underwent catheter ablation. After matching, each group included 2018 patients. Catheter ablation was associated with a lower risk of MACE (2.1% vs 5.0%; HR 0.420, 95% CI 0.294 to 0.600) and heart failure (HR 0.627, 95% CI 0.494 to 0.797). Findings were consistent in the sensitivity analysis and subgroup analyses. In this study, catheter ablation was associated with a lower risk of MACE and heart failure in high-risk patients with newly diagnosed AF. These findings should be interpreted in the context of the selected study population.