Early catheter ablation within 1 year of diagnosis significantly reduced atrial fibrillation recurrence compared to delayed ablation (HR 0.65; 95% CI 0.59-0.73).
Meta-Analysis (n=41,431)
Does early catheter ablation (≤ 1 year from diagnosis) reduce atrial fibrillation recurrence in patients with paroxysmal or persistent atrial fibrillation compared to delayed ablation?
Early catheter ablation within 1 year of AF diagnosis significantly reduces the risk of arrhythmia recurrence and cardiovascular hospitalization compared to delayed ablation, with the greatest benefit observed in patients ≤ 55 years.
Effect estimate: HR 0.65 (95% CI 0.59-0.73)
AIMS: Catheter ablation is a well-established treatment for symptomatic paroxysmal atrial fibrillation (PAF) or persistent atrial fibrillation (PsAF) refractory to antiarrhythmic agents, and current guidelines have also upgraded its role as a first-line option for recurrent PAF. However, the optimal timing to maximize rhythm outcomes remains uncertain. To address this gap, the present study sought to investigate the association between diagnosis-to-ablation time (DAT) and age-stratified atrial fibrillation (AF) recurrence and clinical outcomes. METHODS AND RESULTS: Medline, the Cochrane Library, and Scopus were searched through 18 February 2025. Triple-independent selection, extraction, and quality assessment were conducted, with evidence pooled via random-effects meta-analyses. Among the 28 studies (41 431 participants) with a median 24-month follow-up, early ablation (DAT ≤ 1 year) significantly reduced AF recurrence compared to delayed ablation hazard ratio (HR) 0.65, 95% confidence interval (CI) 0.59-0.73. The benefit of early ablation was consistent for both PAF (HR 0.72, 95% CI 0.67-0.77) and PsAF (HR 0.70, 95% CI 0.61-0.81). Age-stratified analysis revealed that this effect was significant regardless of age, with the greatest risk reduction observed in individuals ≤ 55 years (HR 0.49, 95% CI 0.34-0.71). Early ablation was also associated with a reduced risk of repeat ablation, new cardioversion, and cardiovascular hospitalization compared to delayed ablation. Higher CHA₂DS₂-VASc scores, heart failure prevalence, and lower mean left ventricular ejection fraction were associated with greater benefits from early ablation. CONCLUSION: Early catheter ablation within 1 year of AF diagnosis is associated with a lower risk of recurrence in both PAF and PsAF, with the strongest association observed in patients ≤ 55 years.
Karakasis et al. (Wed,) conducted a meta-analysis in Atrial fibrillation (paroxysmal and persistent) (n=41,431). Early catheter ablation (diagnosis-to-ablation time ≤ 1 year) vs. Delayed ablation was evaluated on Atrial fibrillation recurrence (HR 0.65, 95% CI 0.59-0.73). Early catheter ablation within 1 year of diagnosis significantly reduced atrial fibrillation recurrence compared to delayed ablation (HR 0.65; 95% CI 0.59-0.73).