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. 2022 Sep 3;3(6Part A):639-646.
doi: 10.1016/j.hroo.2022.08.007. eCollection 2022 Dec.

Impact of a dedicated atrial fibrillation clinic on diagnosis-to-ablation time

Andrea Robinson  1 , Nagesh Chopra  1 , Auroa G Badin  1 , Sreedhar R Billakanty  1 , Keaira Cooper  1 , Eugene Y Fu  1 , Jennifer James  1 , Victoria Murnane  1 , Jill Swinning  1 , Mitchell Stelzer  2 , Jaret D Tyler  1 , Anish K Amin  1
Affiliations

Impact of a dedicated atrial fibrillation clinic on diagnosis-to-ablation time

Andrea Robinson et al. Heart Rhythm O2. .

Abstract

Background: Outcomes following catheter ablation (CA) for atrial fibrillation (AF) improve as the diagnosis-to-ablation time (DAT) shortens. Use of a protocol-based integrated care model through a dedicated atrial fibrillation clinic (AFC) may serve to standardize treatment pathways and decrease DAT.

Objective: To evaluate the DAT and clinical characteristics of patients with AF referred from an AFC vs a conventional electrophysiology clinic (EC).

Methods: Retrospective analysis was completed in consecutive patients undergoing index AF ablation at Riverside Methodist Hospital in 2019 with minimum 1 year follow-up. Patients were categorized based off their CA referral source (AFC vs EC) and where the initial visit following index diagnosis of AF occurred (AFC vs EC).

Results: A total of 182 patients (mean age 65 years, 64% male) were reviewed. Patients referred from an AFC (21%) had a median DAT of 342 days (interquartile range [IQR], 125-855 days) compared to patients referred from EC (79%) with a median DAT of 813 days (IQR, 241-1444 days; P = .01). Patients with their index visit following AF diagnosis occurring in the AFC (9%) had significantly shorter median DAT (127 days [IQR, 95-188 days]) compared to EC (91%) (789 days [IQR, 253-1503 days]; P = .002). Patients with DAT <1 year had lower AF recurrence than patients with DAT >1 year (P = .04, hazard ratio = 0.58, 95% confidence interval 0.3418-1.000).

Conclusion: DAT is a modifiable factor that may affect CA outcomes. Significant reductions in DAT were observed in patients evaluated through a dedicated AF clinic.

Keywords: Atrial fibrillation; Atrial fibrillation clinic; Catheter ablation; Diagnosis-to-ablation time; Risk factor modification.

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Figures

Figure 1
Figure 1
Overview of the atrial fibrillation (AF) clinic. A: Flowchart of the acute and nonacute referral pathways into the AF clinic. B: Example of the care plan filled out with the patient at each visit.
Figure 1
Figure 1
Overview of the atrial fibrillation (AF) clinic. A: Flowchart of the acute and nonacute referral pathways into the AF clinic. B: Example of the care plan filled out with the patient at each visit.
Figure 2
Figure 2
Diagnosis-to-ablation time (DAT) in this patient cohort. A: DAT evaluated based on the location of the referral for ablation. B: DAT evaluated based on the location of the first clinic visit following initial diagnosis of atrial fibrillation. AFC = atrial fibrillation clinic; EC = electrophysiology clinic.
Figure 3
Figure 3
Early vs late diagnosis-to-ablation time (DAT) by referral source (N =182). AFC = atrial fibrillation clinic; EC = electrophysiology clinic.
Figure 4
Figure 4
Kaplan-Meier curve for atrial fibrillation (AF) recurrence after ablation. Patients referred for AF ablation with a diagnosis-to-ablation time (DAT) <1 year are significantly more likely to maintain sinus rhythm than those with a DAT >1 year.
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References

    1. January C.T., Wann L.S., Alpert J.S., et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2014;64:e1–e76. - PubMed
    1. Wijffels M.C., Kirchhof C.J., Dorland R., Allessie M.A. Atrial fibrillation begets atrial fibrillation. A study in awake chronically instrumented goats. Circulation. 1995;92:1954–1968. - PubMed
    1. Marrouche N.F., Wilber D., Hindricks G., et al. Association of atrial tissue fibrosis identified by delayed enhancement MRI and atrial fibrillation catheter ablation: the DECAAF study. JAMA. 2014;311:498–506. - PubMed
    1. Hendriks J.M., de Wit R., Crijns H.J., et al. Nurse-led care vs. usual care for patients with atrial fibrillation: results of a randomized trial of integrated chronic care vs. routine clinical care in ambulatory patients with atrial fibrillation. Eur Heart J. 2012;33:2692–2699. - PubMed
    1. Wilber D.J., Pappone C., Neuzil P., et al. Comparison of antiarrhythmic drug therapy and radiofrequency catheter ablation in patients with paroxysmal atrial fibrillation: a randomized controlled trial. JAMA. 2010;303:333–340. - PubMed

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