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. 2025 Jun 22;5(1):245.
doi: 10.1038/s43856-025-00960-1.

Optimal timing for atrial fibrillation patients to undergo catheter ablation

Mingjie Lin #  1   2 , Huan Liang #  1   2 , Kai Zhang  1 , Tongshuai Chen  1 , Juntao Wang  1   2 , Wenqiang Han  1 , Bing Rong  3   4 , Jingquan Zhong  5   6
Affiliations

Optimal timing for atrial fibrillation patients to undergo catheter ablation

Mingjie Lin et al. Commun Med (Lond). .

Abstract

Background: The optimal timing of undergoing catheter ablation for patients with atrial fibrillation (AF) remains uncertain. We aimed 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 analyzed prospective observational data from a single center, including 2097 participants (59.98 ± 10.57 years, 62.7% male) undergoing AF ablation between January 2016 and December 2020. 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 recurs in 512 patients (24.6%). A longer delay per month is significantly associated with a higher recurrence of AF based on multivariable Cox regression analysis [Hazard Ratio (HR) 1.003 (95% CI: 1.001-1.005), p = 0.015]. This association remains consistent in patients with persistent AF (HR compared to DAT ≤ 1 year: 1.548 [95% CI: 1.139-2.102], p = 0.016), but not in those with paroxysmal AF. Left atrial diameter ≥40 mm and female are identified as independent predictors of AF recurrence. The overall impact of DAT on MACCE occurrence is 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 dose not influence the incidence of MACCE. These findings endorse the paradigm shift towards early ablation.

Plain language summary

For patients with atrial fibrillation (AF), a common type of irregular heartbeat, understanding the ideal time to perform catheter ablation, a minimally invasive treatment that uses energy to correct abnormal heart rhythms, is key. In this study, we followed over 2000 patients with AF for about 4 years to see how timing affected treatment success. Findings show patients who had catheter ablation within 3 years of diagnosis were less likely to have their AF return, especially those with long-lasting AF. The study also found women and patients with larger left atrial chambers of the heart had higher risks of their AF returning. These findings suggest earlier catheter ablation helps maintain a normal heart rhythm and can help doctors and patients make more informed decisions about treatment timing.

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Conflict of interest statement

Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1. Flowchart of study (DAT: diagnosis-to-ablation time).
The study included 2097 patients who underwent initial catheter ablation, segmented as follows: 923 patients with DAT ≤ 1 year, 516 patients with 1 year < DAT ≤ 3 years, and 658 patients with DAT > 3 years.
Fig. 2
Fig. 2. DAT and AF recurrence.
Kaplan–Meier curves for cumulative survival free from atrial fibrillation recurrence among groups for overall patients (a, n = 2097) or persistent atrial fibrillation patients (b, n = 807) with long-term follow-up, and for overall patients with 2-year follow-up (c, n = 2097) (DAT diagnosis-to-ablation time).
Fig. 3
Fig. 3. Risk factors of AF recurrence.
Multivariable Cox regression results of atrial fibrillation recurrence for overall patients with long-term (a, n = 2097) or 2-year (b, n = 2097) follow-up. LAD left atrial diameter; DAT diagnosis-to-ablation time.
See this image and copyright information in PMC

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