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Lower Recurrence Rates of Atrial Fibrillation and MACE Events After Early Compared to Late Ablation: A Danish
Jacob Tønnesen1, Martin H Ruwald1, Jannik Pallisgaard1
1Department of Cardiology Herlev-Gentofte University Hospital, University of Copenhagen Hellerup Denmark.
Insights
Early atrial fibrillation ablation significantly reduces recurrence and adverse events like stroke. Delaying ablation increases risks, highlighting the importance of timely intervention for better patient outcomes.
Area of Science:
- Cardiology
- Electrophysiology
- Public Health
Background:
- Current guidelines suggest antiarrhythmic drugs before atrial fibrillation ablation, potentially delaying treatment.
- Delayed ablation may negatively impact treatment efficacy and patient outcomes.
- The study investigates the relationship between diagnosis-to-ablation time and atrial fibrillation recurrence.
Purpose of the Study:
- To determine the impact of the time from diagnosis to ablation on atrial fibrillation recurrence.
- To assess the effect of diagnosis-to-ablation duration on adverse events, including heart failure, stroke, and death.
Main Methods:
- Retrospective analysis of 7705 patients undergoing first-time atrial fibrillation ablation from Danish nationwide registries (2010-2018).
- Patients categorized into four groups based on diagnosis-to-ablation time: <1 year, 1.0-1.9 years, 2.0-2.9 years, and >2.9 years.
- Primary endpoint: atrial fibrillation recurrence; Secondary endpoint: composite of heart failure, ischemic stroke, or death.
Main Results:
- A 5-year cumulative incidence of atrial fibrillation recurrence was 42.9% in the early ablation group (<1 year) versus 58.4% in the late ablation group (>2.9 years).
- Hazard ratios for recurrence increased with delayed ablation, ranging from 1.20 to 1.40 compared to the early group.
- The hazard ratio for the composite secondary endpoint was significantly higher (1.22) in the late ablation group versus the early ablation group.
Conclusions:
- Early atrial fibrillation ablation is associated with a significantly lower risk of recurrence.
- Patients undergoing early ablation experience a significantly reduced risk of major adverse events, including heart failure, stroke, and death.
Background:
Guidelines recommend prioritizing treatment with antiarrhythmic drugs before referral of patients with atrial fibrillation to ablation, delaying a potential subsequent ablation. However, delaying ablation may affect ablation outcomes. We sought to investigate the impact of duration from diagnosis to ablation on the risk of atrial fibrillation recurrence and adverse events.
Methods And Results:
Using Danish nationwide registries, all patients with first-time ablation for atrial fibrillation were identified and included from 2010 to 2018. Patients were divided into 4 groups by diagnosis-to-ablation time: <1.0 year (early ablation), 1.0 to 1.9 years, 2.0 to 2.9 years, and >2.9 years (late ablation). The primary end point was atrial fibrillation recurrence after the 90-day blanking period, defined by admission for atrial fibrillation, cardioversions, use of antiarrhythmic drugs, or repeat atrial fibrillation ablations. The secondary end point was a composite end point of heart failure, ischemic stroke, or death, and each event individually. The study cohort consisted of 7705 patients. The 5-year cumulative incidence of atrial fibrillation recurrence in the 4 groups was 42.9%, 54.8%, 55.9%, and 58.4%, respectively. Hazard ratios were 1.20 (95% CI, 1.07-1.35), 1.29 (95% CI, 1.13-1.47), and 1.40 (95% CI, 1.28-1.53), respectively, with the early ablation group as reference. The hazard ratio for the combined secondary end point was 1.22 (95% CI, 1.04-1.44) in the late ablation group compared with the early ablation group.
Conclusions:
In patients undergoing ablation for atrial fibrillation, early ablation was associated with a significantly lower risk of atrial fibrillation recurrence. Furthermore, the associated risk of heart failure, ischemic stroke, or death was significantly lower in early-compared with late-ablation patients.
