Diagnosis-to-Ablation Time and Atrial Arrhythmia Recurrence After Ablation

Q: What are the key findings of this study?

A diagnosis-to-ablation time of 5 or more years was associated with a 110% increased risk of atrial arrhythmia recurrence at 1 year compared to a time of less than 1 year (HR 2.10).

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Atrial Fibrillation (n=3724). Intervention: Diagnosis-to-ablation time ≥5 years vs. Diagnosis-to-ablation time <1 year. Primary outcome: Atrial arrhythmia recurrence at 1-year follow-up (HR 2.10, 95% CI 1.46-3.02, p=<.001).

Q: What does this research mean for the field?

Prolonged diagnosis-to-ablation time is significantly associated with an increased risk of atrial arrhythmia recurrence following radiofrequency ablation for atrial fibrillation, with risks increasing by 48% for delays of 1 to 4 years and 110% for delays exceeding 5 years. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate whether diagnosis-to-ablation time is associated with atrial arrhythmia recurrence following radiofrequency ablation for atrial fibrillation.

Matthew J. Singleton; Christopher Thorne; Chang Dai; Daniela Hincapie; Daniel Campos-Villarreal; Susan M. Bezenek; Linda Justice; Allyson Varley; Obadah Aloum; Joshua Silverstein; Chinmaya Mareddy; Paul C. Zei; Bruce A. Koplan; Saumil Oza; Anil Rajendra; Matthew Sackett; Edmond Obeng Gmiyah; Matthew Sellers; Ghanshyam Shantha; Amit Thosani; Jefferson H. Lee; Jose Osorio; REAL-AF Investigators; Wai Tam; Srinivas Rajsheker; Alexandru Costea; Rajan Shah; Christopher Woods; Kavisha Patel; Rajat Goyal; Richard Hongo; Steven Kang; Amir Schricker; Smit Vasaiwala; Mohit Rastogi; Devi Nair; Anil Rajendra; Jose Osorio Filho; Gustavo Morales; Francis Benn; Macy Smith; Karl Ilg; Joshua Greenberg; Waddah Maskoun; Arfaat Khan; Mark Lahiri; Mohamad Raad; Matthew Ebinger; Jeremiah Wasserlauf; Alex Ro; Jose Nazari; Mark Metzl; Sunil Vasireddi; Jennifer Wright; Christopher Purtell; Matthew Kalscheur; Ryan Kipp; Daniel Modaff; Blake Fleeman; Majid Mughal; Mohammad Kanjwal; Michael Rehorn; Alap Shah; Tharian Cherian; Amit Thosani; Emerson Liu; Joshua Silverstein; Charles Miller; William Belden; Mati Friehling; George C. Shaw; Subha Varahan; Charles Te; Sarah Levin; Ethan Hoch; David Steckman; Daniel Buerkel; Daniel Pelchovitz; Andrew Noll; Scott Ferreira; John Garner; Paul C. Zei; Bruce A. Koplan; Thomas Tadros; Jorge Romero; Nathaniel Steiger; Dinesh Sharma; Saumil Oza; Anthony Magnano; Benjamin D'Souza; Sandeep Goyal; Michael Hoosien; Kavita Krishnasamy; Ashish Bhimani; Javier Sanchez; Rajeev Joshi; Kamala Tamirisa; Sunil Reddy; Jodie Hurwitz; Brett Gidney

doi:10.1001/jamanetworkopen.2026.23171

July 14, 2026JAMA Network OpenOpen Access

Diagnosis-to-Ablation Time and Atrial Arrhythmia Recurrence After Ablation

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Key result

Diagnosis-to-ablation time ≥5 years linked to ~110% higher 1-year arrhythmia recurrence vs. under 1 year.

HR 2.10
95% CI 1.46-3.02
P<.001
n=3,724

Figures

Why the study?

Limited evidence exists regarding the association of prolonged diagnosis-to-ablation time with ablation outcomes in AF, with previous studies constrained by small sample sizes and methodological heterogeneity.

Does a longer diagnosis-to-ablation time (DAT) increase the risk of atrial arrhythmia recurrence in patients undergoing de novo radiofrequency ablation for atrial fibrillation?

Key Points

To evaluate whether diagnosis-to-ablation time is associated with atrial arrhythmia recurrence following radiofrequency ablation for atrial fibrillation.
Multicenter cohort study of N=3724 patients undergoing de novo radiofrequency ablation for atrial fibrillation between January 2018 and June 2023.
Patients were categorized by diagnosis-to-ablation time into less than 1 year (n=1084), 1 to 4 years (n=1843), and 5 or more years (n=797), with 1-year follow-up.
The primary outcome was recurrent atrial arrhythmia after a 90-day blanking period, evaluated using multivariable Cox regression.
Arrhythmia recurrence occurred in 133 of 1084 (12.3%) patients with diagnosis-to-ablation time under 1 year, 303 of 1843 (16.4%) with 1 to 4 years, and 174 of 797 (21.8%) with 5 or more years.
Compared with diagnosis-to-ablation time less than 1 year, risk of recurrence was significantly higher for 1 to 4 years (HR, 1.48; 95% CI, 1.08-2.01; P = .01) and for 5 or more years (HR, 2.10; 95% CI, 1.46-3.02; P < .001).
Overall procedural complications occurred in 64 patients (1.7%) and did not differ significantly across diagnosis-to-ablation time groups.

Study Design

Type

Cohort (n=3,724)

Multicenter

Yes

Structured PICO

Does a longer diagnosis-to-ablation time (DAT) increase the risk of atrial arrhythmia recurrence in patients undergoing de novo radiofrequency ablation for atrial fibrillation?

P

Population

3,724 adult patients with symptomatic atrial fibrillation undergoing de novo radiofrequency ablation, followed for 1 year.

E

Exposure

Diagnosis-to-ablation time (DAT) of 1 to 4 years or ≥5 years prior to de novo radiofrequency ablation for atrial fibrillation.

C

Comparator

Diagnosis-to-ablation time (DAT) of less than 1 year prior to de novo radiofrequency ablation for atrial fibrillation.

O

Outcome

Freedom from all atrial arrhythmia (symptomatic and asymptomatic) at 1-year follow-up, defined as any documented AF, atrial flutter, or atrial tachycardia lasting ≥30 seconds after a 90-day blanking period.composite

Main Result

Hazard Ratio: 2.1 (95% CI 1.46–3.02)

Absolute Event Rate: 21.8% vs 12.3%

p-value: p=<.001

Prolonged diagnosis-to-ablation time is independently associated with a significantly higher risk of atrial arrhythmia recurrence at 1 year following de novo radiofrequency ablation, underscoring the importance of early rhythm control.

Limitations

Inherent bias associated with nonrandomized observational designs
Procedural parameters were influenced by operator experience
Factors contributing to delays in AF diagnosis may reduce the accuracy of DAT as a surrogate marker
True onset of AF may have preceded clinical diagnosis, potentially underestimating DAT
Voltage-based mapping may underdetect diffuse fibrosis
Lack of standardized rhythm monitoring across sites may have contributed to undetected arrhythmias
Factors contributing to delays in AF diagnosis may reduce the accuracy of DAT as a surrogate marker of atrial remodeling
True onset of AF may have preceded clinical diagnosis, potentially underestimating DAT in some patients

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Implication

May warrant earlier AF ablation referral; extends observational data but leaves causal benefit open for trials.

Abstract

Importance: Diagnosis-to-ablation time (DAT) has emerged as a potential predictor of ablation outcomes in atrial fibrillation (AF). Limited evidence is available on the association of prolonged DAT, and existing studies are constrained by small sample sizes and methodological heterogeneity. Objective: To evaluate whether DAT is associated with atrial arrhythmia recurrence following radiofrequency ablation (RFA) for AF. Design, Setting, and Participants: In this cohort study, patients with AF undergoing de novo RFA from January 2018 to June 2023 in a large, multicenter, clinical practice registry were included. Data were analyzed in August 2024. Exposure: Available DAT and 1-year postablation follow-up. Main Outcomes and Measures: Multivariable Cox regression was used to assess the association between DAT and recurrent atrial arrhythmia (post-blanking period). Results: A total of 3724 patients were included (1492 [40.1%] female; mean [SD] age, 67.0 [10.0] years; mean [SD] BMI, 31.0 [6.8]; and mean [SD] CHA2DS2-VASc score, 2.8 [1.5]). The median (IQR) DAT was 1 (0-4) year, and 2412 (64.8%) underwent RFA for paroxysmal AF. Compared with patients with DAT of less than 1 year, after adjusting for baseline characteristics and comorbidities, patients with DAT of 1 to 4 years had a 48% higher risk of all atrial arrhythmia recurrence (hazard ratio [HR], 1.48; 95% CI, 1.08-2.01; P = .01), and those with DAT greater than 5 years had a 110% increased risk (HR, 2.10; 95% CI, 1.46-3.02; P < .001). Conclusions and Relevance: In this cohort study of patients undergoing de novo RFA, longer DAT was associated with an increased risk of atrial arrhythmia recurrence at 1 year. These results suggest that delayed referral for ablation may be an important prognostic marker in contemporary clinical practice.

Discussion

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Cite This Study

Singleton et al. (2026) conducted a cohort in Atrial Fibrillation (n=3,724). Diagnosis-to-ablation time ≥5 years vs. Diagnosis-to-ablation time <1 year was evaluated on Atrial arrhythmia recurrence at 1-year follow-up (HR 2.10, 95% CI 1.46-3.02, p=<.001). A diagnosis-to-ablation time of 5 or more years was associated with a 110% increased risk of atrial arrhythmia recurrence at 1 year compared to a time of less than 1 year (HR 2.10).

synapsesocial.com/papers/6a5875f72b46c88ba9ad19e4 https://doi.org/10.1001/jamanetworkopen.2026.23171

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Diagnosis-to-Ablation Time and Atrial Arrhythmia Recurrence After Ablation

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Diagnosis-to-Ablation Time and Atrial Arrhythmia Recurrence After Ablation

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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