Key result
Diagnosis-to-ablation time >1 year is linked to up to ~70% higher AF recurrence risk.
Why the study?
Clinical guidelines emphasize rhythm control with catheter ablation but lack guidance on the timing of AF ablation relative to the diagnosis time.
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?
Meta-Analysis (n=43,711)
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?
Effect estimate: 70% increased risk (paroxysmal), 30% increased risk (persistent) for DAT >1 year
p-value: p=<0.01
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.
Shorter diagnosis-to-ablation time may reduce recurrence; extends observational evidence supporting earlier referral in paroxysmal and persistent AF.
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 <0.01). There was a significant decrease in benefit for paroxysmal AF over time and a slight decrease in benefit for persistent AF over time. However, the benefit remained significant in both over time. DAT per year was significantly associated with a 10% increased risk of AF recurrence. Reconstructed Kaplan-Meier analysis showed that DAT >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 <0.01) and showed a trend toward an association with a lower incidence of stroke ( P =0.08). However, there was no significant difference in heart failure between DAT ≤1 year and DAT >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/display_record.php? ; Unique identifier: CRD42024525542.
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Amin et al. (2025) conducted a meta-analysis in Atrial Fibrillation (n=43,711). Diagnosis to ablation time (DAT) ≤1 year vs. DAT >1 year was evaluated on time to first AF recurrence (70% increased risk (paroxysmal), 30% increased risk (persistent) for DAT >1 year, p=<0.01). 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).
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