Impact of early ablation of atrial fibrillation on long-term outcomes: results from phase II/III of the GLORIA-AF registry

Abstract

Background: First-line ablation for atrial fibrillation (AF) reduces the risk of recurrent atrial arrhythmias compared to medical therapy. However, the prognostic benefit of early AF ablation remains undetermined. Herein, we aimed to evaluate the effects of early AF ablation compared to medical therapy.

Methods: Using data from phase II/III of the GLORIA-AF registry, we studied patients who were consecutively enrolled with newly diagnosed AF (< 3 months before baseline visit) and an increased risk of stroke (CHA₂DS₂-VASc ≥ 1). At baseline visit, 445 (1.7%) patients were treated with early AF ablation and 25,518 (98.3%) with medical therapy. Outcomes of interest were the composite outcome of all-cause death, stroke and major bleeding, and pre-specified outcomes of all-cause death, cardiovascular (CV) death, non-CV death, stroke and major bleeding.

Results: A total of 25,963 patients (11733 [45.2%] females; median age 71 [IQR 64-78] years; 17424 [67.1%] taking non-vitamin K antagonist oral anticoagulants [NOACs]) were included. Over a follow-up period of 3.0 (IQR 2.3-3.1) years, after adjustment for confounders, early AF ablation was associated with a significant reduction in the composite outcome of all-cause death, stroke and major bleeding (HR 0.50 [95% CI 0.30-0.85]) and all-cause death (HR 0.45 [95% CI 0.23-0.91]). There were no statistical differences between the groups in terms of CV death, non-CV death, stroke and major bleeding. Similar results were obtained in a propensity-score matched analysis of patients with comparable baseline variables.

Conclusions: Early AF ablation in a contemporary prospective cohort of AF patients who were predominantly treated with NOACs was associated with a survival advantage compared to medical therapy alone.

Trial registration: Clinical trial registration: http://www.

Clinicaltrials: gov . Unique identifiers: NCT01468701, NCT01671007 and NCT01937377. Created with BioRender.com.

Keywords: Early AF ablation; Long-term survival; Newly diagnosed AF; Prognostic benefit.

Fig. 1

Anticoagulation status of patients in study cohort (n = 25,963). OAC oral anticoagulant, VKA vitamin K antagonist

Fig. 2

Kaplan–Meier survival curves for composite outcome of all-cause death, stroke and major bleeding, all-cause death, CV death, non-CV death, stroke and major bleeding

Fig. 3

Effects of early AF ablation in comparison to other risk factors for the composite outcome of all-cause death, stroke and major bleeding. AAD anti-arrhythmic drug, ACE-i angiotensin-converting enzyme inhibitor, AF atrial fibrillation, ARB angiotensin receptor blocker, BMI body mass index, CAD coronary artery disease, COPD chronic obstructive pulmonary disease, CrCl creatinine clearance, DM diabetes mellitus, HF heart failure, HTN hypertension, LVH left ventricular hypertrophy, OAC oral anticoagulation, PAD peripheral artery disease, TE thromboembolism