Does atrial fibrillation ablation really reduce stroke rates?

Atrial fibrillation (AF) is increasingly becoming common among older people, and its prevalence is around 1% of the adult population in North America (roughly 2.2 million people). Patients with AF have an increased risk of strokes, heart failure, and subsequent mortality. Although antiarrhythmic drugs for restoring sinus rhythm have failed to reduce these risks, a subanalysis showed that achieving sinus rhythm was associated with halving the mortality but this effect was negated if antiarrhythmic therapy was continued. In fact, the ATHENA (A placebo-controlled, double-blind, parallel-arm Trial to assess the efficacy of dronedarone 400 mg BID for the prevention of cardiovascular Hospitalization or death from any cause in patiENts with Atrial fibrillation/atrial flutter) trial showed that patients treated with dronedarone had a lower stroke risk over the study follow-up compared to those who received placebo. Over the past decade, catheter ablation has emerged as an alternative therapy for treating AF and is now a widely performed ablation procedure worldwide. Numerous randomized and nonrandomized clinical trials suggest that ablation is more effective than antiarrhythmic drugs in reducing episodes of AF, but its superiority is limited in terms of improving the symptoms and quality of life. The reduction in strokes or mortality rates as the final goal of AF ablation, which has substantial procedural risks, remains to be established. Randomized control trials have long been cons...
Source: Heart Rhythm - Category: Cardiology Authors: Tags: Editorial Commentary Source Type: research