Increasing Time Between First Diagnosis of Atrial Fibrillation and Catheter Ablation Adversely Affects Long-Term Outcomes

Study Question:

Is catheter ablation of atrial fibrillation (AF) more likely to be effective when performed soon after initial diagnosis?

Methods:

In this retrospective study, data were gathered on 4,535 patients (mean age 64 years) who underwent radiofrequency catheter ablation of AF at five hospitals. The primary long-term outcome was the AF recurrence rate at 1 year post-ablation. The patients were separated into four subgroups depending on the time from initial diagnosis of AF: 30-180 days (n = 1,152), 181-545 days (n = 856), 546-1825 days (n = 1,326), and >1,825 days (n = 1,201).

Results:

The mean time from initial AF diagnosis to ablation was 818 days. The mean post-ablation duration of follow-up was 1,184 days. The AF recurrence rate was significantly lower in the subgroup with the shortest time to ablation (19.4%) than in the other groups (23.4-24.9%). This difference persisted after adjustment for confounding variables, including the type of AF. Mortality and heart failure hospitalization rates at 1 year were significantly higher in the two subgroups, with the longest delay in ablation than in the other two subgroups.

Conclusions:

The authors concluded that catheter ablation of AF early after initial diagnosis is associated with improved long-term outcomes independent of whether the AF is paroxysmal or persistent.

Perspective:

The results of this observational study suggest that early intervention in patients with AF is more likely to result in successful outcomes and that this is not simply because of progression of AF. It is possible that time-dependent atrial remodeling adversely affects the results of catheter ablation even when the AF remains paroxysmal. However, whether a delay in ablation because of successful pharmacological rhythm-control therapy also adversely affects long-term outcomes is unclear.

Source: afibprofessional.cardiosource.org