Catheter Ablation of Atrial Fibrillation in U.S. Community Practice--Results From Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF)

Background: the characteristics of patients undergoing atrial fibrillation (af) ablation and subsequent outcomes in community practice are not well described.methods and results: using the outcomes registry for better informed treatment of atrial fibrillation (orbit-af),we investigated the prevalence and impact of catheter ablation of af. among 9935 patients enrolled,5.3% had previous af ablation. patients with af ablation were significantly younger,more frequently male,and had less anemia,chronic obstructive pulmonary disease,and previous myocardial infarction (p<0.05 for all analyses) than those without previous catheter ablation of af. ablated patients were more likely to have a family history of af,obstructive sleep apnea,paroxysmal af,and moderate-to-severe symptoms (p<0.0001 for all analyses). patients with previous ablation were more often in sinus rhythm on entry into the registry (52% vs. 32%; p<0.0001). despite previous ablation,46% in the ablation group were still on antiarrhythmic therapy. oral anticoagulation was prescribed in 75% of those with previous ablation versus 76% in those without previous ablation (p=0.5). the adjusted risk of death (hazard ratio [hr],0.78; 95% confidence interval [ci],0.52 to 1.18; p=0.2) and cardiovascular (cv) hospitalization (hr,1.06; 95% ci,0.90 to 1.26; p=0.5) were similar in both groups. patients with incident af ablation had higher risk of subsequent cv hospitalization than matched patients without incident ablation (hr,1.67; 95% ci,1.24 to 2.26; p=0.0008).conclusions: in u.s. clinical practice,a minority of patients with af are managed with catheter ablation. subsequent to ablation,there were no significant differences in oral anticoagulation use or outcomes,including stroke/non-central nervous system embolism/transient ischemic attack or death.clinical trial registration: url: http://www.clinicaltrials.gov. unique identifier: nct01165710. © 2015 the authors. published on behalf of the american heart association,inc.,by wiley blackwell.