Influence of time to ablation on outcomes among patients with atrial fibrillation with pre-existing heart failure

Abstract

Background: Atrial fibrillation (AF) and heart failure (HF) are cardiac disorders that often coexist.

Objective: This study aimed to investigate how time to ablation could influence the outcomes of AF patients with pre-existing HF.

Methods: Using the 2013 to 2022 Optum Clinformatics database, AF patients with pre-existing HF were classified into 2 groups: early ablation (ablation within 6 months of AF diagnosis) and late ablation (ablation in the 6- to 24-month period after AF diagnosis). Outcomes including AF-related hospitalization, electrical cardioversion, repeat ablation, antiarrhythmic drug (AAD) use, and AF recurrence (a composite outcome of the aforementioned events) were assessed in the postblanking 24-month period. Inverse probability of treatment weighted Poisson regression estimated risk ratio (RR) and 95% confidence interval (CI) for each outcome.

Results: Overall, 601 patients were identified (early ablation: 347; late ablation: 254). In 24 months, the weighted data suggested that patients in the early ablation cohort had significantly lower rate of composite outcome (49.32% vs 61.39%, P = .01), repeat ablation (8.56% vs 17.35%, P < .01), and AAD use (35.95% vs 47.92%, P = .01). Early ablation was associated with a 20%, 51%, and 25% lower risk of composite outcome (RR 0.80, 95% CI 0.69-0.94), repeat ablation (RR 0.49, 95% CI 0.31-0.79), and AAD use (RR 0.75, 95% CI 0.61-0.92), respectively. No significant difference in AF-related hospitalization and electrical cardioversion were observed.

Conclusion: AF patients with pre-existing HF undergoing ablation within 6 months of AF diagnosis have a lower risk of AF recurrence than those undergoing late ablation, which was evidenced by a lower rate of repeat ablation and AAD use.

Keywords: Atrial fibrillation; Cardiology; Catheter ablation; Epidemiology; Heart failure.

Graphical abstract

Figure 1

Flowchart of participants selection. Early ablation was defined as ablation within 6 months after index atrial fibrillation (AF) diagnosis. Late ablation was defined as ablation 6–24 months after the index AF diagnosis. AAD = antiarrhythmic drug; HF = heart failure.

Figure 2

Analysis for association between time to ablation (early vs late) and outcomes within 24 months after catheter ablation (CA). The first 90 days after CA receipt was blanking period, and events that occurred within this period were not treated as the outcome of interest for analysis. Early ablation was defined as ablation within 6 months after index atrial fibrillation (AF) diagnosis. Late ablation was defined as ablation 6 to 24 months after the index AF diagnosis. AAD = antiarrhythmic drug; CI = confidence interval; RR = risk ratio.

Figure 3

Analysis for association between time to ablation (early vs late) and outcomes within 12 months after catheter ablation (CA). The first 90 days after CA receipt was blanking period, and events that occurred within this period were not treated as the outcome of interest for analysis. Early ablation was defined as ablation within 6 months after index atrial fibrillation (AF) diagnosis. Late ablation was defined as ablation 6–24 months after the index AF diagnosis. AAD = antiarrhythmic drug; CI = confidence interval; RR = risk ratio.