"Clinical Outcomes of Pulmonary Vein Isolation Versus Antiarrhythmic Dr" by Yong Hao Yeo, Aravinthan Vignarajah et al.
 

Clinical Outcomes of Pulmonary Vein Isolation Versus Antiarrhythmic Drugs as First-Line Therapy for Atrial Fibrillation: A Propensity Score-Matched Analysis

Document Type

Conference Proceeding

Publication Date

4-1-2025

Publication Title

Journal of the American College of Cardiology

Abstract

Background: Pulmonary vein isolation (PVI) has shown greater efficacy than antiarrhythmic drugs (AAD) for rhythm control in atrial fibrillation (AF). However, large-scale, long-term studies comparing these therapies as first-line treatments in real-world settings are limited. Methods: We used the TriNetX network to identify AF patients (≥18 years) between 2012-2018, comparing those who received either PVI or AAD as first-line therapy. We excluded those who received both after a 3-month blanking period. Patients were followed for 5 years, with the primary outcome being a composite of all-cause death, ischemic stroke, and major bleeding (intracranial or gastrointestinal). Secondary outcomes included all-cause hospitalization and heart failure exacerbation. Results: After propensity score matching, 7,030 patients (3,515 per group) were analyzed. The primary composite outcomes occurred less frequently in patients who had PVI as first-line AF therapy (aOR, 0.47; 95% CI, 0.42 to 0.54; P< 0.01). They had lower odds of all-cause mortality (aOR, 0.32; 95% CI, 0.26 to 0.39; P< 0.01), ischemic stroke (aOR, 0.70; 95% CI, 0.58 to 0.83; P< 0.01) and major bleeding (aOR, 0.49; 95% CI, 0.40 to 0.60; P< 0.01) than the AAD group. They were also associated with lower odds of hospitalizations (aOR, 0.68; 95% CI, 0.62 to 0.75; P< 0.01) and heart failure exacerbations (aOR, 0.72; 95% CI, 0.64 to 0.80; P< 0.01). Conclusion: PVI as first-line AF therapy was associated with better long-term outcomes compared to AAD

Volume

85

Issue

12 Suppl

First Page

265

Comments

American College of Cardiology Meeting, March 29-31, 2025, Chicago, IL

Last Page

265

DOI

10.1016/S0735-1097(25)00750-8

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