Clinical outcomes of pulmonary vein isolation versus antiarrhythmic drugs as first-line therapy for atrial fibrillation: a propensity score-matched analysis.
Document Type
Article
Publication Date
8-23-2025
Publication Title
Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing
Abstract
BACKGROUND: Pulmonary vein isolation (PVI) has increasingly demonstrated superiority over antiarrhythmic drugs (AAD) for rhythm control in atrial fibrillation (AF). However, large-scale, long-term, real-world studies comparing these two therapies as first-line AF management remain limited.
METHODS: Using the TriNetX network, we identified patients (≥ 18 years old) with AF between 2012 and 2019. Patients were categorized into two cohorts: PVI vs. AAD as first-line therapy for AF. Patients were followed for 5 years, with the primary outcome being a composite of all-cause death, all-cause hospitalization, and heart failure exacerbation. Secondary outcomes included ischemic stroke and major bleeding events (intracranial bleeding/ gastrointestinal bleeding). Subanalyses were performed in the paroxysmal and persistent AF cohorts, respectively.
RESULTS: Among 342,230 eligible patients, 2,638 patients (mean age 64.3 ± 10.6 years) who underwent PVI and 2,638 patients (mean age 64.2 ± 13.1 years) who had AAD as first-line therapy for AF had similar propensity scores and were included in the analysis. At 5-year follow-up, the PVI group had a lower risk of the primary composite outcome compared to the AAD group (42.0% vs. 51.1%; HR 0.76; 95% CI, 0.71-0.83; P < 0.01). They also had lower risk of all-cause mortality (4.1% vs. 7.7%; HR 0.53; 95% CI, 0.42-0.67; P < 0.01), all-cause hospitalization (35.1% vs. 42.2%; HR 0.77; 95% CI, 0.71-0.84; P < 0.01), and heart failure exacerbation (21.0% vs. 24.3%; HR 0.85; 95% CI, 0.76-0.95; P < 0.01. Ischemic stroke (6.1% vs. 6.7%; HR 0.90; 95% CI, 0.73-1.12; P = 0.34), and major bleeding event (4.3% vs. 5.3%; HR 0.80; 95% CI, 0.62-1.02; P = 0.08) were similar between groups. Similar outcomes were seen in both the paroxysmal and persistent AF cohorts.
CONCLUSION: After a 5-year follow-up period, PVI was associated with better clinical outcomes than AAD as first-line therapy for AF.
Recommended Citation
Yeo YH, Vignarajah A, Kin Wong HK, Vigneswaramoorthy N, Tan JL, Yeneneh BT et al Clinical outcomes of pulmonary vein isolation versus antiarrhythmic drugs as first-line therapy for atrial fibrillation: a propensity score-matched analysis. J Interv Card Electrophysiol. 2025 Aug 23. doi: 10.1007/s10840-025-02117-5. Epub ahead of print. PMID: 40848209.
DOI
10.1007/s10840-025-02117-5
ISSN
1572-8595
PubMed ID
40848209