Key result
Radiofrequency ablation within 1 year is linked to ~36% fewer cardiovascular events versus after 6 years.
Why the study?
Evidence was lacking regarding the early choice of radiofrequency ablation among patients with early-onset AF.
Does early radiofrequency ablation (diagnosis-to-ablation time ≤ 1 year) reduce composite cardiovascular events and recurrent AF in patients with early-onset atrial fibrillation?
Cohort (n=2,107)
Does early radiofrequency ablation (diagnosis-to-ablation time ≤ 1 year) reduce composite cardiovascular events and recurrent AF in patients with early-onset atrial fibrillation?
Effect estimate: HR 0.64 (95% CI 0.47-0.87)
Absolute Event Rate: 6.1% vs 10.5%
p-value: p=0.005
In patients with early-onset atrial fibrillation, a shorter diagnosis-to-ablation time (≤ 1 year) is associated with significantly lower risks of cardiovascular events and recurrent AF compared to delayed ablation.
May support earlier ablation in early-onset AF; hypothesis-generating observational data requiring RCT confirmation.
BACKGROUND: Evidence was lacking for the early choice of radiofrequency ablation (RFA) among patients with early-onset atrial fibrillation (AF). HYPOTHESIS: This study aimed to explore whether earlier RFA was associated with better clinical outcomes among early-onset AF patients. METHODS: Patients, who were diagnosed with AF before 45 years and underwent their first RFA procedures at baseline of the China Atrial Fibrillation registry, were enrolled and divided into four diagnosis-to-ablation time (DAT) groups: DAT ≤ 1 year, 1 year < DAT ≤ 3 years, 3 years < DAT ≤ 6 years, and DAT > 6 years. Another group of nonablation patients, who were newly diagnosed with AF and younger than 45 years, were also included. Adjusted associations of groups with composite cardiovascular events (cardiovascular death, embolism, major hemorrhages, or cardiac rehospitalization) or recurrent AF were analyzed using Cox proportional hazards models. RESULTS: Among 1694 patients who underwent their first RFA at enrollment, incidences of composite cardiovascular outcomes were increasing with extension of DAT (DAT ≤ 1 year: 6.1/100 person-years, 1 year < DAT ≤ 3 years: 7.9/100 person-years, 3 years < DAT ≤ 6 years: 7.6/100 person-years, DAT > 6 years: 10.5/100 person-years; p < .001). In comparison with DAT > 6 years group, the DAT ≤ 1 year group was associated with reduced risk of cardiovascular events (adjusted hazard ratio, HR [95% confidence interval, CI] = 0.64 [0.47-0.87], p = .005) and AF recurrence (adjusted HR [95% CI] = 0.70 [0.57-0.88], p = .002). Associations remained similar after stratified by AF types. Compared to nonablation group (n = 413), DAT ≤ 1year patients tended to show lower cardiovascular risk (adjusted HR [95% CI] = 0.78 [0.58-1.05], p = .099) and lower risk of recurrent AF (adjusted HR [95% CI] = 0.46 [0.38-0.55], p < .001). CONCLUSIONS: A shorter DAT was associated with a lower risk of cardiovascular events and recurrent AF for early-onset AF patients.
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Zhou et al. (2023) conducted a cohort in Early-onset atrial fibrillation (n=2,107). Diagnosis-to-ablation time (DAT) ≤ 1 year vs. DAT > 6 years and nonablation was evaluated on Composite cardiovascular events (cardiovascular death, embolism, major hemorrhages, or cardiac rehospitalization) (HR 0.64, 95% CI 0.47-0.87, p=0.005). Radiofrequency ablation within 1 year of diagnosis was associated with a reduced risk of cardiovascular events compared to ablation after 6 years (HR 0.64; 95% CI 0.47-0.87; p=0.005).
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