What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Atrial Fibrillation (n=43711). Intervention: Diagnosis to ablation time (DAT) ≤1 year vs. DAT >1 year. Primary outcome: time to first AF recurrence (70% increased risk (paroxysmal), 30% increased risk (persistent) for DAT >1 year, p=<0.01).

February 1, 2025

Impact of Diagnosis to Ablation Time on Recurrence of Atrial Fibrillation and Clinical Outcomes After Catheter Ablation: A Systematic Review and Meta-Analysis With Reconstructed Time-to-Event Data

Q: What are the key findings of this study?

Diagnosis to ablation time >1 year was significantly associated with a 70% increased risk of AF recurrence in paroxysmal AF and 30% in persistent AF compared to ≤1 year (P<0.01).

Key Result

Diagnosis to ablation time >1 year was significantly associated with a 70% increased risk of AF recurrence in paroxysmal AF and 30% in persistent AF compared to ≤1 year (P<0.01).

Study Design

Type

Meta-Analysis (n=43,711)

Structured PICO

Does a shorter diagnosis to ablation time (DAT ≤1 year) reduce AF recurrence and improve clinical outcomes in patients with atrial fibrillation undergoing catheter ablation?

Population

43,711 patients across 23 studies with atrial fibrillation (paroxysmal and persistent) undergoing catheter ablation.

Intervention

Shorter diagnosis to ablation time (DAT), specifically DAT ≤1 year

Comparator

Longer diagnosis to ablation time (DAT), specifically DAT >1 year

Outcome

Time to first AF recurrencehard clinical

Shorter diagnosis to ablation time (≤1 year) is associated with significantly reduced AF recurrence and all-cause mortality in patients with paroxysmal and persistent atrial fibrillation.

Main Result

Effect estimate: 70% increased risk (paroxysmal), 30% increased risk (persistent) for DAT >1 year

p-value: p=<0.01

Abstract

BACKGROUND: Current clinical guidelines emphasize the significance of rhythm control with catheter ablation but lack guidance on the timing of atrial fibrillation (AF) ablation relative to the diagnosis time. We aim to investigate the latest evidence on the impact of diagnosis to ablation time (DAT) on clinical outcomes after AF ablation. METHODS: We searched PubMed, Web of Science, Scopus, Embase, and Cochrane Central Register of Controlled Trials through August 2024. Pairwise, prognostic, and reconstructed time-to-event data meta-analyses were conducted using R V. 4. 3. 1. Our primary end point was time to first AF recurrence, with secondary end points of all-cause mortality, tamponade, stroke, and heart failure. RESULTS: Our cohort included 23 studies with 43 711 patients. Shorter DAT was significantly associated with reduced AF recurrence across both paroxysmal and persistent AF subgroups (P 1 year was significantly associated with a 70% increased risk of AF recurrence in paroxysmal AF and 30% in persistent AF. DAT ≤1 year was significantly associated with decreased all-cause mortality (P 1 year. CONCLUSIONS: Early ablation is more beneficial in paroxysmal AF, with a notable decrease in benefit over time, while in persistent AF, the benefit remains significant but slightly decreases over time. Shorter DAT was significantly associated with decreased all-cause mortality and showed a trend toward an association with a lower incidence of stroke. REGISTRATION: URL: https: //www. crd. york. ac. uk/prospero/displayᵣecord. php? ; Unique identifier: CRD42024525542.