OBJECTIVES : To compare resource utilization and outcomes among patients with atrial fibrillation (AF) undergoing ablation procedures versus antiarrhythmic drug (AAD) treatment.

METHODS : A retrospective cohort design using the Clinical Practice Research Data-Hospital Episode Statistics linkage data from England was used. Patients undergoing catheter ablation treatment for AF during the period January 2008-December 2013 were identified, with the first date of procedure being the index date. For the AAD cohort, patients with AF with record of at least two different AADs between January 2008-December 2013, with first fill of second AAD classified as index date, were identified. Inpatient care and outpatient visits were compared between the two groups in the 4-12 month post-index period (first three months were considered blanking period). Clinical outcomes including heart failure, stroke, cardioversion, mortality, and a composite outcome were compared for the 4 months-3 years post-index period in the two groups. Using 1:1 propensity matching (greedy macro), patients in the two groups were matched on demographic, procedural, and clinical characteristics. Cox-proportional hazards model was used for clinical outcomes analysis.

RESULTS : In the 4-12 month period, a total of 558 patients were matched in the two groups for resource utilization comparison. The average number of cardiovascular (CV)-related outpatient visits were significantly lower in the ablation group versus the AAD group (1.76 vs 3.57,p<.0001). For major outcomes comparison in the 4 months-3 year period, 615 matched patients in each group emerged. Ablation patients had ~38% lower risk of heart failure (hazard ratio [HR] 0.62,p=0.0318), ~50% lower risk of mortality (HR 0.50,p=0.0082), and ~43% lower risk of having a composite outcome (HR 0.57,p=0.0009) as compared to patients undergoing AAD treatment. No significant difference in other outcomes emerged.

CONCLUSIONS : AF ablation was associated with significantly lower resource utilization, and lower risk of heart failure and mortality versus AAD therapy.