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Clinical outcomes of ablation versus non-ablation therapy for atrial fibrillation in Japan: analysis of pooled data from the AF Frontier Ablation Registry and SAKURA AF Registry

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Abstract

Whether ablation for atrial fibrillation (AF) is, in terms of clinical outcomes, beneficial for Japanese patients has not been clarified. Drawing data from 2 Japanese AF registries (AF Frontier Ablation Registry and SAKURA AF Registry), we compared the incidence of clinically relevant events (CREs), including stroke/transient ischemic attack (TIA), major bleeding, cardiovascular events, and death, between patients who underwent ablation (n = 3451) and those who did not (n = 2930). We also compared propensity-score matched patients (n = 1414 in each group). In propensity-scored patients who underwent ablation and those who did not, mean follow-up times were 27.2 and 35.8 months, respectively. Annualized rates for stroke/TIA (1.04 vs. 1.06%), major bleeding (1.44 vs. 1.20%), cardiovascular events (2.15 vs. 2.49%) were similar (P = 0.96, 0.39, and 0.35, respectively), but annualized death rates were lower in the ablation group than in the non-ablation group (0.75 vs.1.28%, P = 0.028). After multivariate adjustment, the risk of CREs was statistically equivalent between the ablation and non-ablation groups (hazard ratio [HR] 0.89, 95% confidence interval [CI] 0.71–1.11), but it was significantly low among patients who underwent ablation for paroxysmal AF (HR 0.68 [vs. persistent AF], 95% CI 0.49–0.94) and had a CHA2DS2-VASc score  < 3 (HR 0.66 [vs. CHA2DS2-VASc score ≥ 3], 95% CI 0.43–0.98]). The 2-year risk reduction achieved by ablation may be small among Japanese patients, but AF ablation may benefit those with paroxysmal AF and a CHA2DS2-VASc score < 3.

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References

  1. Cosedis Nielsen J, Johannessen A, Raatikainen P, Hindricks G, Walfridsson H, Kongstad O, Pehrson S, Englund A, Hartikainen J, Mortensen LS, Hansen PS (2012) Radiofrequency ablation as initial therapy in paroxysmal atrial fibrillation. N Engl J Med 367:1587–1595

    Article  Google Scholar 

  2. Khan AR, Khan S, Sheikh MA, Khuder S, Grubb B, Moukarbel GV (2014) Catheter ablation and antiarrhythmic drug therapy as first- or second-line therapy in the management of atrial fibrillation: Systematic review and meta-analysis. Circ Arrhythm Electrophysiol 7:853–860

    Article  CAS  Google Scholar 

  3. Hoffmann E, Straube F, Wegscheider K, Kuniss M, Andresen D, Wu LQ, Tebbenjohanns J, Noelker G, Tilz RR, Chun JKR, Franke A, Stellbrink C, Garcia-Alberola A, Dorwarth U, Metzner A, Ouarrak T, Brachmann J, Kuck KH, Senges J; FREEZE Cohort Study Investigators (2019) Outcomes of cryoballoon or radiofrequency ablation in symptomatic paroxysmal or persistent atrial fibrillation. Europace 21:1313–1324

    Article  Google Scholar 

  4. Bunch TJ, Crandall BG, Weiss JP, May HT, Bair TL, Osborn JS, Anderson JL, Muhlestein JB, Horne BD, Lappe DL, Day JD (2011) Patients treated with catheter ablation for atrial fibrillation have long-term rates of death, stroke, and dementia similar to patients without atrial fibrillation. J Cardiovasc Electrophysiol 22:839–845

    Article  Google Scholar 

  5. Chang CH, Lin JW, Chiu FC, Caffrey JL, Wu LC, Lai MS (2014) Effect of radiofrequency catheter ablation for atrial fibrillation on morbidity and mortality: a nationwide cohort study and propensity score analysis. Circ Arrhythm Electrophysiol 7:76–82

    Article  Google Scholar 

  6. Karasoy D, Gislason GH, Hansen J, Johannessen A, Køber L, Hvidtfeldt M, Özcan C, Torp-Pedersen C, Hansen ML (2015) Oral anticoagulation therapy after radiofrequency ablation of atrial fibrillation and the risk of thromboembolism and serious bleeding: Long-term follow-up in nationwide cohort of Denmark. Eur Heart J 36:307–314a

    Article  Google Scholar 

  7. Friberg L, Tabrizi F, Englund A (2016) Catheter ablation for atrial fibrillation is associated with lower incidence of stroke and death: data from Swedish health registries. Eur Heart J 37:2478–2487

    Article  Google Scholar 

  8. Marrouche NF, Brachmann J, Andresen D, Siebels J, Boersma L, Jordaens L, Merkely B, Pokushalov E, Sanders P, Proff J, Schunkert H, Christ H, Vogt J, Bänsch D, Investigators CASTLE-AF (2018) Catheter ablation for atrial fibrillation with heart failure. N Engl J Med 378:417–427

    Article  Google Scholar 

  9. Packer DL, Mark DB, Robb RA, Monahan KH, Bahnson TD, Poole JE, Noseworthy PA, Rosenberg YD, Jeffries N, Mitchell LB, Flaker GC, Pokushalov E, Romanov A, Bunch TJ, Noelker G, Ardashev A, Revishvili A, Wilber DJ, Cappato R, Kuck KH, Hindricks G, Davies DW, Kowey PR, Naccarelli GV, Reiffel JA, Piccini JP, Silverstein AP, Al-Khalidi HR, Lee KL, Investigators CABANA (2019) Effect of catheter ablation vs antiarrhythmic drug therapy on mortality, stroke, bleeding, and cardiac arrest among patients with atrial fibrillation: the CABANA randomized clinical trial. JAMA 321:1261–1274

    Article  CAS  Google Scholar 

  10. Kodani E, Atarashi H, Inoue H, Okumura K, Yamashita T, Origasa H, Registry Investigators J-RHYTHM (2016) Beneficial effect of non-vitamin K antagonist oral anticoagulants in patients with nonvalvular atrial fibrillation: results of the J-RHYTHM Registry 2. Circ J 80:843–851

    Article  CAS  Google Scholar 

  11. Suzuki S, Yamashita T, Okumura K, Atarashi H, Akao M, Ogawa H, Inoue H (2015) Incidence of ischemic stroke in Japanese patients with atrial fibrillation not receiving anticoagulation therapy—pooled analysis of the Shinken Database, J-RHYTHM Registry, and Fushimi AF Registry. Circ J 79:432–438

    Article  Google Scholar 

  12. Okumura Y, Yokoyama K, Matsumoto N, Tachibana E, Kuronuma K, Oiwa K, Matsumoto M, Kojima T, Hanada S, Nomoto K, Arima K, Takahashi F, Kotani T, Ikeya Y, Fukushima S, Itou S, Kondo K, Chiku M, Ohno Y, Onikura M, Hirayama A, Registry Invertigators SAKURA AF (2018) Three-year clinical outcomes associated with warfarin vs. direct oral anticoagulant use among Japanese patients with atrial fibrillation—findings from the SAKURA AF Registry. Circ J 82:2500–2509

    Article  CAS  Google Scholar 

  13. Verma A, Jiang CY, Betts TR, Chen J, Deisenhofer I, Mantovan R, Macle L, Morillo CA, Haverkamp W, Weerasooriya R, Albenque JP, Nardi S, Menardi E, Novak P, Sanders P, Investigators STARAFII (2015) Approaches to catheter ablation for persistent atrial fibrillation. N Engl J Med 372:1812–1822

    Article  Google Scholar 

  14. Okumura Y, Nagashima K, Arai M, Watanabe R, Yokoyama K, Matsumoto N, Otsuka T, Suzuki S, Hirata A, Murakami M, Takami M, Kimura M, Fukaya H, Nakahara S, Kato T, Shimizu W, Iwasaki YK, Hayashi H, Harada T, Nakajima I, Okumura K, Koyama J, Tokuda M, Yamane T, Momiyama Y, Tanimoto K, Soejima K, Nonoguchi N, Ejima K, Hagiwara N, Harada M, Sonoda K, Inoue M, Kumagai K, Hayashi H, Satomi K, Yazaki Y, Watari Y, Registry Investigators AF Frontier Ablation (2019) Current status and clinical outcomes of oral anticoagulant discontinuation after ablation for atrial fibrillation in Japan—findings from the AF Frontier Ablation Registry. Circ J 83:2418–2427

    Article  Google Scholar 

  15. Okumura Y, Yokoyama K, Matsumoto N, Tachibana E, Kuronuma K, Oiwa K, Matsumoto M, Kojima T, Hanada S, Nomoto K, Arima K, Takahashi F, Kotani T, Ikeya Y, Fukushima S, Itoh S, Kondo K, Chiku M, Ohno Y, Onikura M, Hirayama A, Registry Investigators SAKURA AF (2017) Current use of direct oral anticoagulants for atrial fibrillation in Japan: findings from the SAKURA AF Registry. J Arrhythm 33:289–296

    Article  Google Scholar 

  16. Nagashima K, Okumura Y, Watanabe I, Nakahara S, Hori Y, Iso K, Watanabe R, Arai M, Wakamatsu Y, Kurokawa S, Mano H, Nakai T, Ohkubo K, Hirayama A (2018) Hot balloon versus cryoballoon ablation for atrial fibrillation: lesion characteristics and middle-term outcomes. Circ Arrhythm Electrophysiol 11:e005861

    Article  Google Scholar 

  17. Mansour M, Heist EK, Agarwal R, Bunch TJ, Karst E, Ruskin JN, Mahapatra S (2018) Stroke and cardiovascular events after ablation or antiarrhythmic drugs for treatment of patients with atrial fibrillation. Am J Cardiol 121:1192–1199

    Article  Google Scholar 

  18. Freeman JV, Tabada GH, Reynolds K, Sung SH, Singer DE, Wang PJ, Liu TI, Gupta N, Hlatky MA, Go AS (2020) Comparison of long-term adverse outcomes in patients with atrial fibrillation having ablation versus antiarrhythmic medications. Am J Cardiol 125:553–561

    Article  Google Scholar 

  19. Modin D, Claggett B, Gislason G, Hansen ML, Worck R, Johannessen A, Hansen J, Svendsen JH, Pallisgaard JL, Schou M, Køber L, Solomon SD, Torp-Pedersen C, Biering-Sørensen T (2020) Catheter ablation for atrial fibrillation is associated with lower incidence of heart failure and death. Europace 22:74–83

    Article  Google Scholar 

  20. Freeman JV, Shrader P, Pieper KS, Allen LA, Chan PS, Fonarow GC, Gersh BJ, Kowey PR, Mahaffey KW, Naccarelli G, Reiffel JA, Singer DE, Go AS, Hylek EM, Steinberg BA, Peterson ED, Piccini JP (2019) Outcomes and anticoagulation use after catheter ablation for atrial fibrillation. Circ Arrhythm Electrophysiol 12:e007612

    Article  Google Scholar 

  21. Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, Akar JG, Badhwar V, Brugada J, Camm J, Chen PS, Chen SA, Chung MK, Nielsen JC, Curtis AB, Davies DW, Day JD, d’Avila A, de Groot NMSN, Di Biase L, Duytschaever M, Edgerton JR, Ellenbogen KA, Ellinor PT, Ernst S, Fenelon G, Gerstenfeld EP, Haines DE, Haissaguerre M, Helm RH, Hylek E, Jackman WM, Jalife J, Kalman JM, Kautzner J, Kottkamp H, Kuck KH, Kumagai K, Lee R, Lewalter T, Lindsay BD, Macle L, Mansour M, Marchlinski FE, Michaud GF, Nakagawa H, Natale A, Nattel S, Okumura K, Packer D, Pokushalov E, Reynolds MR, Sanders P, Scanavacca M, Schilling R, Tondo C, Tsao HM, Verma A, Wilber DJ, Yamane T (2017) 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm 14:e275–e444

    Article  Google Scholar 

Download references

Acknowledgements

The authors wish to thank all of the centers that participated in this study and all of the patients who provided their consented to the use of their data. We thank Ms. Wendy Alexander–Adams for their encouragement and assistance with the reporting of our findings in English.

Funding

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

Author information

Authors and Affiliations

  1. Division of Cardiology, Department of Medicine, Itabashi Hospital, Nihon University School of Medicine, Ohyaguchi-Kamicho, Itabashi-ku, Tokyo, 173-8610, Japan

    Kazuki Iso, Koichi Nagashima, Masaru Arai, Ryuta Watanabe & Yasuo Okumura

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

    Katsuaki Yokoyama & Naoya Matsumoto

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

    Takayuki Otsuka & Shinya Suzuki

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

    Akio Hirata

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

    Masato Murakami

  6. Saiseikai Nakatsu Hospital, Osaka, Japan

    Mitsuru Takami

  7. Department of Cardiology, Hirosaki University Hospital, Aomori, Japan

    Masaomi Kimura

  8. Kitasato University Hospital, Kanagawa, Japan

    Hidehira Fukaya

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

    Shiro Nakahara

  10. Kanazawa University Hospital, Ishikawa, Japan

    Takeshi Kato

  11. Nippon Medical Hospital, Tokyo, Japan

    Hiroshi Hayashi, Yu-ki Iwasaki & Wataru Shimizu

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

    Ikutaro Nakajima & Tomoo Harada

  13. Saiseikai Kumamoto Hospital, Kumamoto, Japan

    Junjiroh Koyama & Ken Okumura

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

    Michifumi Tokuda & Teiichi Yamane

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

    Kojiro Tanimoto & Yukihiko Momiyama

  16. Kyorin University Hospital, Tokyo, Japan

    Noriko Nonoguchi & Kyoko Soejima

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

    Koichiro Ejima & Nobuhisa Hagiwara

  18. Fujita Health University Hospital, Aichi, Japan

    Masahide Harada

  19. Tokyo Rinkai Hospital, Tokyo, Japan

    Kazumasa Sonoda

  20. Ishikawa Prefectural Central Hospital, Ishikawa, Japan

    Masaru Inoue

  21. Gunma Cardiovascular Center, Gunma, Japan

    Koji Kumagai

  22. Juntendo University, Tokyo, Japan

    Hidemori Hayashi

  23. Tokyo Medical University Hospital, Tokyo, Japan

    Yoshinao Yazaki & Kazuhiro Satomi

  24. Teikyo University, Tokyo, Japan

    Yuji Watari

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  1. Kazuki Iso
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for the AF Ablation Frontier Registry investigators

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Correspondence to Yasuo Okumura.

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Conflict of interest

The following authors have potential conflicts of interest. Nihon University Itabashi Hospital, Clinical Research Judging Committee (No. RK-161213-06 and RK-130111-2). YO has 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. NM has received research funding from Daiichi-Sankyo. SS received research funding from Daiichi-Sankyo and Mitsubishi-Tanabe. AH has received accepted remuneration from Nippon Boehringer Ingelheim, Bayer Healthcare, Bristol-Myers Squibb, Daiichi-Sankyo. MK has received accepted remuneration from Johnson & Johnson K.K., Medtronic Japan, Bayer Healthcare. HF has received lecture fees from Nippon Boehringer Ingelheim and Daiichi-Sankyo. SN has received lecture fees from Bayer Healthcare, Daiichi-Sankyo, Bristol-Meyers Squibb, Pfizer Japan, and Nippon Boehringer Ingelheim. TK has received 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. WS has received research funding from Bristol-Myers Squibb, Daiichi-Sankyo, and Nippon Boehringer Ingelheim, patent royalties/licensing fees from Daiichi-Sankyo, Pfizer Japan, Bristol-Myers Squibb, Bayer Healthcare, and Nippon Boehringer Ingelheim, and he is the Circulation Journal Editorial Team. TH serves as a consultant to Medtronic Japan and has received lecture fees from Daiichi-Sankyo. IN has received a scholarship from the Japanese Heart Rhythm Society and received speaking honoraria from Medtronic Japan. K.O. has received remuneration from Nippon Boehringer Ingelheim, Daiichi-Sankyo, Johnson & Johnson, and Medtronic Japan. MT serves as a consultant to Medtronic Japan. TY has received lecture fees from Daiichi-Sankyo and Abbott Medical Japan. KT has received lecture fees from Daiichi-Sankyo, Nippon Boehringer Ingelheim, Bristol-Myers Squibb, Pfizer Japan, Bayer Healthcare. KS has received research funding from Daiichi-Sankyo and Nippon Boehringer Ingelheim, and accepted remuneration from Medtronic Japan, Jonson & Jonson, and Abbott Medical Japan. NH has received accepted remuneration from Nippon Boehringer Ingelheim, Bristol-Myers Squibb, Bayer Healthcare, and research funding from Bayer Healthcare, Nippon Boehringer Ingelheim, Daiichi-Sankyo, and he is the Circulation Journal Editorial Team. MH has lecture fee from Nippon Boehringer Ingelheim and Bristol-Myers Squibb. KS and YA have received research funding from BIOTRONIK Japan. Other authors have no conflict of interest.

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Iso, K., Nagashima, K., Arai, M. et al. Clinical outcomes of ablation versus non-ablation therapy for atrial fibrillation in Japan: analysis of pooled data from the AF Frontier Ablation Registry and SAKURA AF Registry. Heart Vessels 36, 549–560 (2021). https://doi.org/10.1007/s00380-020-01721-x

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