What does this research mean for the field?

Early catheter ablation within three years of diagnosis improves atrial fibrillation-free survival, particularly in patients with persistent AF, but does not significantly reduce the incidence of major adverse cardiovascular and cerebrovascular events. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

February 6, 2024Open Access

Optimal Timing for Atrial Fibrillation Patients to Undergo Catheter Ablation: Insights from Long-Term Outcome Studies

MLMingjie LinQingdao University BRBing RongChinese Academy of Medical Sciences & Peking Union Medical College KZKai ZhangChinese Academy of Medical Sciences & Peking Union Medical College

Structured PICO

Does early catheter ablation (shorter diagnosis-to-ablation time) reduce atrial fibrillation recurrence and MACCE in patients with atrial fibrillation?

Population

2,097 patients undergoing initial catheter ablation for atrial fibrillation at a single center, mean age 59.98 ± 10.57 years, 62.7% male.

Intervention

Early catheter ablation, defined as a diagnosis-to-ablation time (DAT) of ≤ 1 year or > 1 to ≤ 3 years.

Comparator

Delayed catheter ablation, defined as a diagnosis-to-ablation time (DAT) of > 3 years.

Outcome

Atrial fibrillation recurrence and major adverse cardiovascular and cerebrovascular events (MACCE: stroke, transient ischemic attacks, systemic embolic incidents, acute myocardial infarction, advanced heart failure, and mortality).composite

Early catheter ablation within 3 years of diagnosis improves long-term maintenance of sinus rhythm in patients with persistent atrial fibrillation, though it does not significantly reduce major adverse cardiovascular and cerebrovascular events compared to delayed ablation.

Abstract

Abstract Background Despite catheter ablation being an established treatment for atrial fibrillation (AF), optimal timing for this procedure to improve long-term outcomes remains uncertain. Objective To investigate the impact of diagnosis-to-ablation time (DAT) on AF recurrence and major adverse cardiovascular and cerebrovascular events (MACCE) following catheter ablation. Methods This study retrospectively analyzed prospective observational data from a single center, including 2,097 participants undergoing AF ablation between January 2016 and December 2020. Baseline characteristics, clinical outcomes, and the incidence of MACCE were evaluated. Patients were stratified by DAT: ≤ 1 year, > 1 to ≤ 3 years, and > 3 years. Cox proportional hazards and logistic regression analyses were used to identify predictors of AF recurrence and MACCE Results During the 46.89 ± 16.46 months follow-up, AF recurred in 512 patients (24.6%). Early intervention (DAT ≤ 1 year or ≤ 3 years) corresponded with higher AF-free survival, particularly in patients with persistent AF (HR reference to DAT ≤ 1 year: 1.548 95%CI: 1.139–2.102). Patients with DAT > 3 years had higher risks of AF recurrence within two years, but long-term recurrence rates stabilized across DAT groups. Left atrial diameter ≥ 40 mm and female gender were identified as independent predictors of AF recurrence. The overall impact of DAT on MACCE occurrence was not significant, with age and vascular disease being independent predictors. Conclusions Early catheter ablation is preferable for maintaining sinus rhythm, particularly in persistent AF. However, DAT did not influence the incidence of MACCE. These findings endorse the paradigm shift towards early ablation but also emphasize the importance of personalized treatment strategies based on individual patient profiles.

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