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Impact of sinus rhythm maintenance on major adverse cardiac and cerebrovascular events after catheter ablation of atrial fibrillation: insights from AF frontier ablation registry

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Abstract

The impact of catheter ablation for atrial fibrillation (AF) on cardiovascular events and mortality is controversial. We investigated the impact of sinus rhythm maintenance on major adverse cardiac and cerebrovascular events after AF ablation from a Japanese multicenter cohort of AF ablation. We investigated 3326 consecutive patients (25.8% female, mean age 63.3 ± 10.3 years) who underwent catheter ablation for AF from the atrial fibrillation registry to follow the long-term outcomes and use of anti coagulants after ablation (AF frontier ablation registry). The primary endpoint was a composite of stroke, transient ischemic attack, cardiovascular events, and all-cause death. During a mean follow-up of 24.0 months, 2339 (70.3%) patients were free from AF after catheter ablation, and the primary composite endpoint occurred in 144 (4.3%) patients. The AF nonrecurrence group had a significantly lower incidence of the primary endpoint (1.8 per 100 person-years) compared with the AF recurrence group (3.0 per 100 person-years, p = 0.003). The multivariate analysis revealed that freedom from AF (hazard ratio 0.61, 95% confidence interval 0.44–0.86, p = 0.005) was independently associated with the incidence of the composite event. In the multicenter cohort of AF ablation, sinus rhythm maintenance after catheter ablation was independently associated with lower rates of major adverse cardiac and cerebrovascular events.

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Acknowledgement

None.

Funding

This study was supported by a research grant from Bristol-Meyers Squibb.

Author information

Authors and Affiliations

  1. Department of Cardiovascular Medicine, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan

    Keisuke Usuda, Takeshi Kato, Toyonobu Tsuda, Hayato Tada, Satoru Niwa, Soichiro Usui, Kenji Sakata, Kenshi Hayashi, Hiroshi Furusho, Masaaki Kawashiri & Masayuki Takamura

  2. Department of Cardiology, The Cardiovascular Institute, Tokyo, Japan

    Takayuki Otsuka & Shinya Suzuki

  3. Cardiovascular Division, Osaka Police Hospital, Osaka, Japan

    Akio Hirata

  4. Divison of Cardiology, Shonan-Kamakura General Hospital, Kanagawa, Japan

    Masato Murakami

  5. Saiseikai Nakatsu Hospital, Osaka, Japan

    Mitsuru Takami

  6. Divison of Cardiology, Pulmonary Medicine and Nephrology, Hirosaki University School of Medicine, Aomori, Japan

    Masaomi Kimura

  7. Kitasato University Hospital, Kanagawa, Japan

    Hidehira Fukaya

  8. Dokkyo Medical University Saitama Medical Center, Saitama, Japan

    Shiro Nakahara

  9. Nippon Medical Hospital, Tokyo, Japan

    Wataru Shimizu, Yu-ki Iwasaki & Hiroshi Hayashi

  10. St. Marianna University School of Medicine Hospital, Kanagawa, Japan

    Tomoo Harada & Ikutaro Nakajima

  11. Saiseikai Kumamoto Hospital, Kumamoto, Japan

    Ken Okumura & Junjiroh Koyama

  12. Tokyo Jikei University School of Medicine Hospital, Tokyo, Japan

    Michifumi Tokuda & Teiichi Yamane

  13. National Hospital Organization Tokyo Medical Center, Tokyo, Japan

    Yukihiko Momiyama & Kojiro Tanimoto

  14. Kyorin University Hospital, Tokyo, Japan

    Kyoko Soejima & Noriko Nonoguchi

  15. Tokyo Women’s Medical University Hospital, Tokyo, Japan

    Koichiro Ejima & Nobuhisa Hagiwara

  16. Fujita University Health Hospital, Aichi, Japan

    Masahide Harada

  17. Tokyo Rinkai Hospital, Tokyo, Japan

    Kazumasa Sonoda

  18. Ishikawa Prefectural Central Hospital, Ishikawa, Japan

    Masaru Inoue

  19. Gunma Cardiovascular Center, Gunma, Japan

    Koji Kumagai

  20. Juntendo University, Tokyo, Japan

    Hidemori Hayashi

  21. Tokyo Medical University Hospital, Tokyo, Japan

    Kazuhiro Satomi & Yoshinao Yazaki

  22. Teikyo University, Tokyo, Japan

    Yuji Watari

  23. Division of Cardiology, Nihon University Itabashi Hospital, Tokyo, Japan

    Masaru Arai, Ryuta Watanabe, Koichi Nagashima & Yasuo Okumura

  24. Department of Cardiology, Nihon University Hospital, Tokyo, Japan

    Katsuaki Yokoyama & Naoya Matsumoto

Authors
  1. Keisuke Usuda
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  2. Takeshi Kato
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  3. Toyonobu Tsuda
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  4. Hayato Tada
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  5. Satoru Niwa
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  7. Kenji Sakata
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  8. Kenshi Hayashi
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  9. Hiroshi Furusho
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  11. Masayuki Takamura
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  12. Takayuki Otsuka
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  13. Shinya Suzuki
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  15. Masato Murakami
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  17. Masaomi Kimura
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  18. Hidehira Fukaya
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  19. Shiro Nakahara
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  20. Wataru Shimizu
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  21. Yu-ki Iwasaki
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  22. Hiroshi Hayashi
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  23. Tomoo Harada
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  24. Ikutaro Nakajima
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  25. Ken Okumura
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  26. Junjiroh Koyama
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  27. Michifumi Tokuda
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  28. Teiichi Yamane
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  29. Yukihiko Momiyama
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  30. Kojiro Tanimoto
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  31. Kyoko Soejima
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  32. Noriko Nonoguchi
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  33. Koichiro Ejima
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  34. Nobuhisa Hagiwara
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  35. Masahide Harada
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  36. Kazumasa Sonoda
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  37. Masaru Inoue
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  38. Koji Kumagai
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  39. Hidemori Hayashi
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  40. Kazuhiro Satomi
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  41. Yoshinao Yazaki
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  42. Yuji Watari
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  43. Masaru Arai
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  44. Ryuta Watanabe
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  45. Katsuaki Yokoyama
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  46. Naoya Matsumoto
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  47. Koichi Nagashima
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  48. Yasuo Okumura
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Consortia

on behalf of the AF Ablation Frontier Registry

Corresponding author

Correspondence to Takeshi Kato.

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Conflict of interest

The following authors have potential conflicts of interest: T.K. received a research grant from Daiichi-Sankyo, and lecture fees from Bristol-Myers Squibb, Daiichi-Sankyo and Nippon Boehringer Ingelheim, and honoraria for writing promotional material for Bristol-Myers Squibb. S.S. received research funding from Daiichi-Sankyo and Mitsubishi-Tanabe. A.H. accepted remuneration from Nippon Boehringer Ingelheim, Bayer Healthcare, Bristol-Myers Squibb, Daiichi-Sankyo. M. Kimura accepted remuneration from Johnson & Johnson K.K., Medtronic Japan, Bayer Healthcare. H. Fukaya received lecture fees from Nippon Boehringer Ingelheim and Daiichi-Sankyo. S. Nakahara received lecture fees from Bayer Healthcare, Daiichi-Sankyo, Bristol-Meyers Squibb, Pfizer Japan, and Nippon Boehringer Ingelheim. W.S. received research funding from Bristol–Myers Squibb, Daiichi-Sankyo, and Nippon Boehringer Ingelheim, and patent royalties/licensing fees from Daiichi-Sankyo, Pfizer Japan, Bristol-Myers Squibb, Bayer Healthcare, and Nippon Boehringer Ingelheim. T.H. serves as a consultant to Medtronic Japan and has received lecture fees from Daiichi-Sankyo. I.N. received a scholarship from the Japanese Heart Rhythm Society and speaking honoraria from Medtronic Japan. K.O. received remuneration from Nippon Boehringer Ingelheim, Daiichi-Sankyo, Johnson & Johnson, and Medtronic Japan. M. Tokuda serves as a consultant to Medtronic Japan. T.Y. received lecture fees from Daiichi-Sankyo and Abbott Medical Japan. K.T. received lecture fees from Daiichi-Sankyo, Nippon Boehringer Ingelheim, Bristol-Myers Squibb, Pfizer Japan, Bayer Healthcare. K. Soejima received research funding from Daiichi-Sankyo and Nippon Boehringer Ingelheim, and accepted remuneration from Medtronic Japan, Jonson & Jonson, and Abbott Medical Japan. N.H. accepted remuneration from Nippon Boehringer Ingelheim, Bristol-Myers Squibb, Bayer Healthcare, and research funding from Bayer Healthcare, Nippon Boehringer Ingelheim, Daiichi-Sankyo. M.H. received lecture fee from Nippon Boehringer Ingelheim, Daiichi-Sankyo, and Johnson & Johnson. K. Satomi and Y.Y. received research funding from BIOTRONIK Japan. N.M. received research funding from Daiichi-Sankyo. Y.O. received research funding from Bayer Healthcare, Daiichi-Sankyo, Bristol-Meyers Squibb, Nippon Boehringer Ingelheim, Pfizer Japan, TORAY, and Boston Scientific Japan and has accepted remuneration from Bayer Healthcare, Daiichi-Sankyo, and Bristol-Meyers Squibb. Other authors have no conflicts of interest.

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The protocol of this study was approved by Institutional Review Board of Nihon University Itabashi Hospital (RK-161213–6) along with the Institutional Review Boards of all participating institutions.

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Usuda, K., Kato, T., Tsuda, T. et al. Impact of sinus rhythm maintenance on major adverse cardiac and cerebrovascular events after catheter ablation of atrial fibrillation: insights from AF frontier ablation registry. Heart Vessels 37, 327–336 (2022). https://doi.org/10.1007/s00380-021-01929-5

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