Key result
PVI within one year of AF diagnosis linked to ~57% higher 5-year success versus late ablation.
Why the study?
Does shorter diagnosis-to-ablation time improve clinical success (freedom from AF) in patients with atrial fibrillation undergoing pulmonary vein isolation?
Cohort (n=1,000)
Does shorter diagnosis-to-ablation time improve clinical success (freedom from AF) in patients with atrial fibrillation undergoing pulmonary vein isolation?
Absolute Event Rate: 55.9% vs 35.5%
p-value: p=<0.001
Shorter diagnosis-to-ablation time for pulmonary vein isolation in atrial fibrillation is associated with significantly higher long-term clinical success rates, advocating for early intervention.
Earlier ablation associated with higher success; hypothesis-generating and leaves open need for randomized confirmation.
Aims: The aim of the study is to define long-term outcome of pulmonary vein isolation (PVI) in atrial fibrillation (AF) and to determine whether time window between AF diagnosis and PVI affects outcome. Methods and results: Consecutive AF patients undergoing PVI (2006-14) were followed for 5 years. Primary outcome was clinical success, defined as freedom of documented AF without anti-arrhythmic drugs respecting a 1-month blanking period. A 1000 patients were included (age 60 ± 10 years, CHA2DS2-VASc score 1 ± 1). The cohort was divided in four quartiles (Q) according to the diagnosis-to-ablation time (DAT): Q1 DAT 0-11 months (N = 244), Q2 DAT 12-≤33 months (N = 254), Q3 DAT 34-≤70 months (N = 252) and Q4 DAT 71-360 months (N = 250). Mean follow-up was 44.3±21.0 months. At 5 years, clinical success was achieved in 45.2 ± 2.0% of patients. Independent predictors of clinical success were AF type (HR = 0.61; 95%CI 0.50-0.74; P < 0.0001), left atrial size (HR = 1.03; 95%CI 1.02-1.05; P < 0.0001), DAT (HR = 1.00; 95%CI 1.00-1.00; P = 0.001), ablation technique (P = 0.012), and year of ablation (HR = 0.93; 95%CI 0.86-1.00; P = 0.045) in multivariable-adjusted analysis. The highest clinical success was achieved when PVI was performed within the first year, and gradually declined with increasing DAT: 55.9 ± 4.6% for Q1, 46.9 ± 4.0% for Q2, 45.5 ± 3.6% for Q3, and 35.5 ± 3.6% for Q4 (P < 0.001). Conclusion: Long-term success rate of PVI is 45.2 ± 2.0%. Shorter diagnosis-to-ablation times are associated with better clinical success. Our data advocate for early PVI following diagnosis of AF.
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Greef et al. (2017) conducted a cohort in atrial fibrillation (n=1,000). Early pulmonary vein isolation (diagnosis-to-ablation time 0-11 months) vs. Delayed pulmonary vein isolation (diagnosis-to-ablation time 71-360 months) was evaluated on clinical success (freedom of documented AF without anti-arrhythmic drugs respecting a 1-month blanking period) (p=<0.001). Pulmonary vein isolation performed within the first year of atrial fibrillation diagnosis yielded higher 5-year clinical success (55.9%) than ablation after 71-360 months (35.5%, P<0.001).