Clinical outcomes of pulmonary vein isolation versus antiarrhythmic drugs as first-line therapy for atrial fibrillation: a propensity score-matched analysis.
Yong Hao Yeo, Aravinthan Vignarajah, Hermon Kha Kin Wong, Nishanthi Vigneswaramoorthy, Jian Liang Tan, Beeletsega T Yeneneh, Luis Scott, Komandoor Srivathsan, Justin Lee, Dan Sorajja
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引用次数: 0
Abstract
Background: Pulmonary vein isolation (PVI) has increasingly demonstrated superiority over antiarrhythmic drugs (AAD) for rhythm control in atrial fibrillation (AF). However, large-scale, long-term, real-world studies comparing these two therapies as first-line AF management remain limited.
Methods: Using the TriNetX network, we identified patients (≥ 18 years old) with AF between 2012 and 2019. Patients were categorized into two cohorts: PVI vs. AAD as first-line therapy for AF. Patients were followed for 5 years, with the primary outcome being a composite of all-cause death, all-cause hospitalization, and heart failure exacerbation. Secondary outcomes included ischemic stroke and major bleeding events (intracranial bleeding/ gastrointestinal bleeding). Subanalyses were performed in the paroxysmal and persistent AF cohorts, respectively.
Results: Among 342,230 eligible patients, 2,638 patients (mean age 64.3 ± 10.6 years) who underwent PVI and 2,638 patients (mean age 64.2 ± 13.1 years) who had AAD as first-line therapy for AF had similar propensity scores and were included in the analysis. At 5-year follow-up, the PVI group had a lower risk of the primary composite outcome compared to the AAD group (42.0% vs. 51.1%; HR 0.76; 95% CI, 0.71-0.83; P < 0.01). They also had lower risk of all-cause mortality (4.1% vs. 7.7%; HR 0.53; 95% CI, 0.42-0.67; P < 0.01), all-cause hospitalization (35.1% vs. 42.2%; HR 0.77; 95% CI, 0.71-0.84; P < 0.01), and heart failure exacerbation (21.0% vs. 24.3%; HR 0.85; 95% CI, 0.76-0.95; P < 0.01. Ischemic stroke (6.1% vs. 6.7%; HR 0.90; 95% CI, 0.73-1.12; P = 0.34), and major bleeding event (4.3% vs. 5.3%; HR 0.80; 95% CI, 0.62-1.02; P = 0.08) were similar between groups. Similar outcomes were seen in both the paroxysmal and persistent AF cohorts.
Conclusion: After a 5-year follow-up period, PVI was associated with better clinical outcomes than AAD as first-line therapy for AF.
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