Pimentel Rhea C, Khanna Rahul, Maccioni Sonia, Zhang Dongyu, Piccini Jonathan P
XXX, The University of Kansas Health System, Kansas City, Kansas.
XXX, MedTech Epidemiology and Real-World Data Sciences, Johnson & Johnson, New Brunswick, New Jersey.
Heart Rhythm. 2025 Aug 14. doi: 10.1016/j.hrthm.2025.07.061.
Catheter ablation (CA) has a Class I indication for first-line rhythm control for atrial fibrillation (AF).
This study aimed to compare the safety and effectiveness of CA vs antiarrhythmic drug (AAD) for first-line rhythm control therapy in clinical practice.
Persons with incident AF (2015-2022) in the Optum Clinformatics cohort were categorized by the first-line treatment they received (CA or AAD). The incidence of hospitalization for atrial arrhythmia (AF, atrial flutter, or tachycardia) at 1-year (3-month blanking period) was compared between CA and AAD. Cox regression with inverse probability of treatment weighting was used to compare outcomes between treatment groups.
A total of 2711 CA-treated (mean age 66.4 ± 10.7 years, 39.8% woman) and 22,726 AAD-treated (mean age 70.3 ± 11.4 years, 52.2% woman) persons with a new diagnosis of AF were included. Patients undergoing CA as the first-line therapy had a 48% lower risk (adjusted hazard ratio [HR] = 0.52, 95% confidence interval [CI] 0.40-0.68) of hospitalization for atrial arrhythmia, a 52% lower risk of AF-related electrical cardioversion (HR = 0.48, 95% CI 0.34-0.68), and a 74% lower risk of hospitalization for heart failure (HR = 0.26, 95% CI 0.13-0.54) compared with those receiving first-line AAD therapy. Lower risks of atrial arrhythmia hospitalization were also found with first-line CA receipt vs AAD in paroxysmal (HR = 0.52, 95% CI 0.37-0.73) and persistent AF (HR = 0.55, 95% CI 0.37-0.81).
First-line CA for both paroxysmal and persistent AF is associated with significantly lower risk of hospitalization for atrial arrhythmia consistent with results from randomized clinical trials and current Class I guideline recommendations.
导管消融术（CA）是心房颤动（AF）一线节律控制的I类适应证。
本研究旨在比较在临床实践中，CA与抗心律失常药物（AAD）用于一线节律控制治疗的安全性和有效性。
Optum临床信息队列中2015 - 2022年发生AF的患者，根据其接受的一线治疗（CA或AAD）进行分类。比较CA组和AAD组在1年时（3个月空白期）房性心律失常（AF、心房扑动或心动过速）的住院发生率。采用逆概率加权的Cox回归来比较治疗组之间的结局。
共纳入2711例接受CA治疗的患者（平均年龄66.4±10.7岁，女性占39.8%）和22726例接受AAD治疗的患者（平均年龄70.3±11.4岁，女性占52.2%），均为新诊断的AF患者。与接受一线AAD治疗的患者相比，接受CA作为一线治疗的患者房性心律失常住院风险降低48%（调整后风险比[HR]=0.52，95%置信区间[CI]0.40 - 0.68），AF相关电复律风险降低52%（HR = 0.48，95% CI 0.34 - 0.68），心力衰竭住院风险降低74%（HR = 0.26，95% CI 0.13 - 0.54）。在阵发性（HR = 0.52，95% CI 0.37 - 0.73）和持续性AF（HR = 0.55，95% CI 0.37 - 0.81）中，与AAD相比，接受一线CA治疗的患者房性心律失常住院风险也较低。
阵发性和持续性AF的一线CA治疗与房性心律失常住院风险显著降低相关，这与随机临床试验结果和当前I类指南推荐一致。
