Diagnosis-to-ablation time predicts recurrent atrial fibrillation and rehospitalization following catheter ablation

Abstract

Background: Wait times for catheter ablation in patients with symptomatic atrial fibrillation (AF) may influence clinical outcomes.

Objective: This study examined the relationship between the duration from AF diagnosis to ablation, or diagnosis-to-ablation time (DAT), on the clinical response to catheter ablation in a large nationwide cohort of patients.

Methods: We identified patients with new AF who underwent catheter ablation between January 2014 and December 2017 using the IBM MarketScan databases. Cox proportional hazard models were used to estimate the strength of the association between DAT and the outcomes of AF recurrence and hospitalization at 1 year postablation.

Results: Among 11,143 AF patients who underwent ablation, the median age was 59 years, 31% were female, and the median CHA₂DS₂-VASc score was 2. Median DAT was 5.5 (2.6, 13.1) months. At 1 year postablation, 10.0% (n = 1116) developed recurrent AF. For each year increase in DAT, the risk of AF recurrence increased by 20% after adjustment for baseline comorbidities and medications (hazard ratio [HR] 1.20, 95% confidence interval [CI] 1.11-1.30). A longer DAT was associated with an increased risk of hospitalization (HR 1.08 per DAT year, 95% CI 1.02-1.15). DAT was a stronger predictor of AF recurrence postablation than traditional clinical risk factors, including age, prior heart failure, or renal failure.

Conclusion: Increasing duration between AF diagnosis and catheter ablation is associated with higher AF recurrence rates and all-cause hospitalization. Our findings are consistent with a growing body of evidence supporting the benefits of prioritizing early restoration of sinus rhythm.

Keywords: Atrial fibrillation; Catheter ablation; Predictors; Recurrence; Rehospitalization.

Graphical abstract

Figure 1

Adjusted event rates at 1 year for A: atrial fibrillation (AF) recurrence and B: first all-cause hospitalization. DAT = diagnosis-to-ablation time.

Figure 2

Product-limit failure curves for 1-year (A) atrial fibrillation (AF) recurrence and (B) first all-cause hospitalization, stratified by diagnosis-to-ablation time (DAT) ≤1 year and >1 year.