Key result
Longer AF diagnosis-to-ablation time is linked to ~2% more adverse postprocedural outcomes per month.
Why the study?
Previous studies evaluated diagnosis-to-ablation time as a categorical variable and did not assess outcomes according to referral-to-ablation wait times.
Does longer diagnosis-to-ablation or referral-to-ablation time increase the risk of adverse clinical outcomes in patients undergoing catheter ablation for atrial fibrillation?
Cohort (n=7,472)
Yes
Does longer diagnosis-to-ablation or referral-to-ablation time increase the risk of adverse clinical outcomes in patients undergoing catheter ablation for atrial fibrillation?
Effect estimate: HR 1.02 per month (95% CI 1.01-1.02)
Delays between atrial fibrillation diagnosis and referral for ablation, but not between referral and ablation, are associated with worse postprocedural clinical outcomes.
Earlier AF diagnosis-to-referral delays were associated with worse post-ablation outcomes; leaves open whether expediting referral improves prognosis.
BACKGROUND: Rhythm control is a cornerstone of atrial fibrillation (AF) management. Shorter time between diagnosis of AF and receipt of catheter ablation is associated with greater rates of therapy success. Previous work considered diagnosis-to-ablation time as a binary or categorical variable and did not consider the unique risk profile of patients after a referral for ablation was made. OBJECTIVE: The purpose of this study was to comprehensively assess the impact of diagnosis-to-ablation and referral-to-ablation time on postprocedural outcomes at a population level. METHODS: This observational cohort study included patients who received catheter ablation to treat AF in Ontario, Canada. Patient demographics, medical comorbidities, AF diagnosis date, ablation referral date, and ablation date were collected. The primary outcomes of interest included a composite of death and hospitalization/emergency department visit for AF, heart failure, or ischemic stroke. Multivariable Cox models assessed the impact of diagnosis-to-ablation and referral-to-ablation times on the primary outcome. RESULTS: Our cohort included 7472 patients who received ablation for de novo AF between April 1, 2016, and March 31, 2022. Median [interquartile range] diagnosis-to-ablation time was 718 [399-1274] days and median referral-to-ablation time was 221 [117-363] days. Overall, 911 patients (12.2%) had the composite endpoint within 1 year of ablation. Increasing diagnosis-to-ablation time was associated with a greater incidence for the primary outcome (hazard ratio [HR]1.02; 95% confidence interval [CI] 1.01-1.02 per month). Increasing referral-to-ablation time did not impact the primary outcome (HR 1.00; 95% CI 0.98-1.01 per month). CONCLUSION: Delays between AF diagnosis and ablation referral may contribute to adverse postprocedural outcomes and provide an opportunity for health system quality improvements.
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Qeska et al. (2024) conducted a cohort in Atrial fibrillation (n=7,472). Diagnosis-to-ablation time vs. Referral-to-ablation time was evaluated on Composite of death and hospitalization/emergency department visit for AF, heart failure, or ischemic stroke (HR 1.02 per month, 95% CI 1.01-1.02). Increasing diagnosis-to-ablation time for atrial fibrillation was associated with a greater incidence of adverse postprocedural outcomes (HR 1.02 per month; 95% CI 1.01-1.02).
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