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Canadian Journal of Cardiology

Mortality Risk Associated with Atrial Fibrillation Ablation: No Harm No Foul

  • Jason G. Andrade
    Affiliations
    University of British Columbia, Vancouver, Canada

    Center for Cardiovascular Innovation, Vancouver, Canada

    Montreal Heart Institute, Université de Montréal, Montréal, Canada
    Search for articles by this author
  • Laurent Macle
    Correspondence
    Corresponding author: Dr. Laurent Macle, Cardiac electrophysiologist, Professor of Medicine, Université de Montréal, Chief of the electrophysiology service, Montreal Heart Institute, 5000 est, rue Bélanger, Montreal (Qc), Canada, H1T 1C8 Tel: (514) 376-3330, ext 4075
    Affiliations
    Montreal Heart Institute, Université de Montréal, Montréal, Canada
    Search for articles by this author
      Atrial fibrillation (AF) is the most common cardiac sustained heart rhythm disorder encountered in clinical practice, with current estimates suggesting it affects up to 3% of the general population.
      • Andrade J.G.
      • Aguilar M.
      • Atzema C.
      • et al.
      The 2020 Canadian Cardiovascular Society/Canadian Heart Rhythm Society Comprehensive Guidelines for the Management of Atrial Fibrillation.
      In addition to reductions in quality of life, AF is responsible for the majority of arrhythmia-related healthcare utilization (emergency room visits and hospital admissions), and is associated with a significant risk of stroke/systemic thromboembolism, cognitive dysfunction, and premature mortality.
      • Andrade J.G.
      • Aguilar M.
      • Atzema C.
      • et al.
      The 2020 Canadian Cardiovascular Society/Canadian Heart Rhythm Society Comprehensive Guidelines for the Management of Atrial Fibrillation.
      ,
      • Andrade J.
      • Khairy P.
      • Dobrev D.
      • Nattel S.
      The clinical profile and pathophysiology of atrial fibrillation: relationships among clinical features, epidemiology, and mechanisms.
      Over the past 25 years, percutaneous catheter ablation, which is centered on electrical isolation of triggering foci within the pulmonary veins, has moved from an investigational therapy to the standard of care for sinus rhythm maintenance as both an initial (“first-line”) and “second-line” therapy (i.e., when antiarrhythmic drugs have been ineffective, are contraindicated, or produce intolerable adverse effects).
      • Andrade J.G.
      • Aguilar M.
      • Atzema C.
      • et al.
      The 2020 Canadian Cardiovascular Society/Canadian Heart Rhythm Society Comprehensive Guidelines for the Management of Atrial Fibrillation.
      ,
      • Asad Z.U.A.
      • Yousif A.
      • Khan M.S.
      • Al-Khatib S.M.
      • Stavrakis S.
      Catheter Ablation Versus Medical Therapy for Atrial Fibrillation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
      • Andrade J.G.
      • Wazni O.M.
      • Kuniss M.
      • et al.
      Cryoballoon Ablation as Initial Treatment for Atrial Fibrillation: JACC State-of-the-Art Review.
      • Cheung C.C.
      • Nattel S.
      • Macle L.
      • Andrade J.G.
      Management of Atrial Fibrillation in 2021: An Updated Comparison of the Current CCS/CHRS, ESC, and AHA/ACC/HRS Guidelines.
      In addition to reducing arrhythmia recurrence, catheter ablation provides clinically meaningful benefits on patient-reported outcomes, clinically important improvements in quality of life and exercise performance, significantly reduces healthcare resource utilization, and does not increase the risk of adverse events compared with pharmacotherapy.
      • Asad Z.U.A.
      • Yousif A.
      • Khan M.S.
      • Al-Khatib S.M.
      • Stavrakis S.
      Catheter Ablation Versus Medical Therapy for Atrial Fibrillation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
      ,
      • Andrade J.G.
      • Wazni O.M.
      • Kuniss M.
      • et al.
      Cryoballoon Ablation as Initial Treatment for Atrial Fibrillation: JACC State-of-the-Art Review.
      As a result, catheter ablation of AF has become the most commonly performed ablation procedure in most electrophysiology centers worldwide, with an annual population-adjusted growth rate that exceeds all other cardiovascular procedures.
      • Kumar S.
      • Walters T.E.
      • Halloran K.
      • et al.
      Ten-year trends in the use of catheter ablation for treatment of atrial fibrillation vs. the use of coronary intervention for the treatment of ischaemic heart disease in Australia.
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