Catheter ablation of atrial fibrillation (AF) has become a therapy of choice to treat symptomatic AF in current practice. As an alternative, atrioventricular node (AVN) ablation is an older but efficient procedure to control ventricular rate.

To assess long-term clinical outcomes of AF ablation and AVN ablation in large cohort of patients with AF and to compare these two procedures.

This French multicentric retrospective study enrolled all patients hospitalized with a primary or secondary diagnosis of AF from 1st January 2010 to 31st December 2019, using an administrative hospital-discharge database. Clinical outcomes were analyzed in overall population and in propensity-matched samples.

During follow-up (mean [SD]: 2.0 [2.2], median [IQR]: 1.0 [0.1–3.3] years), 2,438,015 patients were analysed (no ablation 2,360,833, AF ablation 62,490 and AVN ablation 14,692). Compared to patients treated without ablation, incidence of all-cause death was lower in patients treated with AF ablation [hazard ratio (HR): 0.272, 95% confidence interval (CI): 0.259–0.287, P<0.0001] or AVN ablation (HR: 0.762, 95% CI: 0.734–0.791, P<0.0001). After propensity-score matching, in patients treated with AF ablation, incidence of all-cause death (HR: 0.662, 95% CI: 0.557–0.788, P<0.0001), cardiovascular death (HR: 0.617, 95% CI: 0.471–0.807, P<0.0001) and hospitalization for heart failure (HF) (HR: 0.732, 95% CI: 0.620–0.865, P<0.0001) were lower compared to patients treated with AVN ablation, unlike incidence of ischemic stroke (HR: 1.447, 95% CI: 1.122–1.865, P<0.0001) (Fig. 1).

AF ablation and AVN ablation may be associated with better survival compared to non-invasive strategy. Compared to AVN ablation, AF ablation is associated with lower risk of all-cause death, cardiovascular death and hospitalization for HF, but higher incidence of ischemic stroke.