Key result
Early catheter ablation within 1 year cuts AF recurrence ~35% versus delayed ablation.
Why the study?
Although catheter ablation is well established for symptomatic PAF or PsAF, the optimal timing of ablation to maximize rhythm outcomes remains uncertain.
Does early catheter ablation (≤ 1 year from diagnosis) reduce atrial fibrillation recurrence in patients with paroxysmal or persistent atrial fibrillation compared to delayed ablation?
Meta-Analysis (n=41,431)
Does early catheter ablation (≤ 1 year from diagnosis) reduce atrial fibrillation recurrence in patients with paroxysmal or persistent atrial fibrillation compared to delayed ablation?
Early catheter ablation within 1 year of AF diagnosis significantly reduces the risk of arrhythmia recurrence and cardiovascular hospitalization compared to delayed ablation, with the greatest benefit observed in patients ≤ 55 years.
Supports early ablation referral after AF diagnosis to cut recurrence; reinforces timing as key to ablation success across AF subtypes.
AIMS: Catheter ablation is a well-established treatment for symptomatic paroxysmal atrial fibrillation (PAF) or persistent atrial fibrillation (PsAF) refractory to antiarrhythmic agents, and current guidelines have also upgraded its role as a first-line option for recurrent PAF. However, the optimal timing to maximize rhythm outcomes remains uncertain. To address this gap, the present study sought to investigate the association between diagnosis-to-ablation time (DAT) and age-stratified atrial fibrillation (AF) recurrence and clinical outcomes. METHODS AND RESULTS: Medline, the Cochrane Library, and Scopus were searched through 18 February 2025. Triple-independent selection, extraction, and quality assessment were conducted, with evidence pooled via random-effects meta-analyses. Among the 28 studies (41 431 participants) with a median 24-month follow-up, early ablation (DAT ≤ 1 year) significantly reduced AF recurrence compared to delayed ablation [hazard ratio (HR) 0.65, 95% confidence interval (CI) 0.59-0.73]. The benefit of early ablation was consistent for both PAF (HR 0.72, 95% CI 0.67-0.77) and PsAF (HR 0.70, 95% CI 0.61-0.81). Age-stratified analysis revealed that this effect was significant regardless of age, with the greatest risk reduction observed in individuals ≤ 55 years (HR 0.49, 95% CI 0.34-0.71). Early ablation was also associated with a reduced risk of repeat ablation, new cardioversion, and cardiovascular hospitalization compared to delayed ablation. Higher CHA₂DS₂-VASc scores, heart failure prevalence, and lower mean left ventricular ejection fraction were associated with greater benefits from early ablation. CONCLUSION: Early catheter ablation within 1 year of AF diagnosis is associated with a lower risk of recurrence in both PAF and PsAF, with the strongest association observed in patients ≤ 55 years.
No takes yet. Share an insight, caveat, or question.
Karakasis et al. (2025) conducted a meta-analysis in Atrial fibrillation (paroxysmal and persistent) (n=41,431). Early catheter ablation (diagnosis-to-ablation time ≤ 1 year) vs. Delayed ablation was evaluated on Atrial fibrillation recurrence (HR 0.65, 95% CI 0.59-0.73). Early catheter ablation within 1 year of diagnosis significantly reduced atrial fibrillation recurrence compared to delayed ablation (HR 0.65; 95% CI 0.59-0.73).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: