Optimal Timing for Atrial Fibrillation Patients to Undergo Catheter Ablation: Insights from Long-Term Outcome Studies

Abstract Background Despite catheter ablation being an established treatment for atrial fibrillation (AF), optimal timing for this procedure to improve long-term outcomes remains uncertain. Objective To investigate the impact of diagnosis-to-ablation time (DAT) on AF recurrence and major adverse cardiovascular and cerebrovascular events (MACCE) following catheter ablation. Methods This study retrospectively analyzed prospective observational data from a single center, including 2,097 participants undergoing AF ablation between January 2016 and December 2020. Baseline characteristics, clinical outcomes, and the incidence of MACCE were evaluated. Patients were stratified by DAT: ≤ 1 year, > 1 to ≤ 3 years, and > 3 years. Cox proportional hazards and logistic regression analyses were used to identify predictors of AF recurrence and MACCE Results During the 46.89 ± 16.46 months follow-up, AF recurred in 512 patients (24.6%). Early intervention (DAT ≤ 1 year or ≤ 3 years) corresponded with higher AF-free survival, particularly in patients with persistent AF (HR reference to DAT ≤ 1 year: 1.548 95%CI: 1.139–2.102). Patients with DAT > 3 years had higher risks of AF recurrence within two years, but long-term recurrence rates stabilized across DAT groups. Left atrial diameter ≥ 40 mm and female gender were identified as independent predictors of AF recurrence. The overall impact of DAT on MACCE occurrence was not significant, with age and vascular disease being independent predictors. Conclusions Early catheter ablation is preferable for maintaining sinus rhythm, particularly in persistent AF. However, DAT did not influence the incidence of MACCE. These findings endorse the paradigm shift towards early ablation but also emphasize the importance of personalized treatment strategies based on individual patient profiles.