PMC:6019327 / 68934-71494
Annnotations
{"target":"https://pubannotation.org/docs/sourcedb/PMC/sourceid/6019327","sourcedb":"PMC","sourceid":"6019327","source_url":"https://www.ncbi.nlm.nih.gov/pmc/6019327","text":"It is widely recognized that AF ablation is effective in controlling AF and its associated symptoms. Multiple studies have demonstrated that AF ablation improves QOL in a patient with symptomatic AF, including those with HF.231,232 Many patients with AF have HF with reduced ejection fraction (EF). Multiple studies have examined the effect of ablation on EF.63,76,233,234,235,236 In a meta-analysis of nine studies of AF ablation in patients with HF, mean EF improved 11% (95% confidence interval [CI] 6.9–15.3, P \u003c.001).237 The effect of ablation on the future risk of stroke is of great interest, partly because of the morbidity and mortality associated with stroke, but also because of the need to inform decisions regarding continuing anticoagulation in patients with apparently successful ablations. A number of studies, but not all, have reported a low stroke rate in patients who have undergone AF ablation when followed long term.238,239,240,241,242 Although the results of these studies taken as a whole report a lower than expected stroke rate, these results can be considered preliminary data because many of these trials enrolled patients with a CHA2DS2-VASc score of \u003c2, in whom stroke rates will be anticipated to be low. This reflects the fact that very few patients with a high stroke risk profile were followed long term after suspension of anticoagulation. Notably, it has recently been shown that patients with PAF have a lower stroke rate than those with persistent AF.51 These observations, while preliminary, are supportive of the emerging belief that AF ablation could in fact reduce stroke risk. The ultimate proof that elimination of AF by ablation lowers stroke risk will require a large, prospective, randomized clinical trial such as CABANA. Limited studies have evaluated the effect of ablation on the risk of dementia. Prior studies have reported that Alzheimer’s dementia occurred in 0.2% of AF ablation patients compared with 0.9% of patients with AF who did not have ablation and 0.5% of patients without AF (P \u003c.0001). Other types of dementia were also reduced significantly in patients who had undergone ablation.239 Although these findings are of interest, they must be considered preliminary because this was not a prospective randomized trial. The impact of AF ablation on mortality is also uncertain. Although a number of preliminary studies have reported encouraging results, not all studies have reported a reduction in mortality. These results must also be considered preliminary due to their study 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