Five-year outcomes following catheter ablation for paroxysmal atrial fibrillation: a propensity matched analysis of 51 182 patients from a real world cohort

Abstract Aims Atrial fibrillation (AF) poses significant risks of stroke and mortality. Catheter ablation (CA) has emerged as a superior rhythm control strategy compared with medical therapy, but its long-term benefits in AF, in ischaemic stroke prevention, remain underexplored. Methods and results This observational study analysed data from the TriNetX Research Network, encompassing over 115 million patients. Adults diagnosed with paroxysmal atrial fibrillation (PAF) between 2012 and 2019 were stratified into CA and non-CA groups. Propensity score matching (PSM) accounted for baseline differences in demographics, comorbidities, and medication use. The primary outcome was ischaemic stroke rates at five years, with and without prior ischaemic stroke. Secondary outcomes included all-cause mortality. Kaplan–Meier survival analysis and Cox proportional hazards regression were used to estimate adjusted hazard ratios (HRs). Among 791 013 patients with PAF, 53 178 (6.7%) underwent CA. Post-PSM, ischaemic stroke rates were significantly lower in the CA group (7.96% vs. 9.52%, HR: 0.823, 95% confidence interval, CI: 0.785–0.863, P < 0.0001), even after excluding patients with prior ischaemic stroke (de novo ischaemic stroke) (4.70% vs. 6.43% HR: 0.709, 95% CI: 0.665–0.756, P < 0.0001). All-cause mortality was markedly reduced (9.33% vs. 20.68% HR: 0.388, 95% CI: 0.373–0.404, P < 0.0001). Conclusion This large-scale study demonstrates that in PAF patients CA is associated with lower ischaemic stroke rates and all-cause mortality compared with a PSM group without CA. These findings support urgent evaluation of CA in managing PAF and highlight its role in potentially improving survival and reducing stroke risk. Further trials are needed to support these findings.