Relationship between wait times and postatrial fibrillation ablation outcomes: A population-based study

Area of Science:

• Cardiology
• Medical Informatics

Background:

• Rhythm control is crucial for managing atrial fibrillation (AF).
• Shorter time from AF diagnosis to catheter ablation correlates with better treatment success.
• Previous studies did not fully account for patient risk profiles post-ablation referral.

Purpose of the Study:

• To evaluate the population-level impact of diagnosis-to-ablation and referral-to-ablation times on post-catheter ablation outcomes.
• To analyze the relationship between treatment delays and patient prognosis after AF ablation.

Main Methods:

• Observational cohort study of 7472 patients undergoing catheter ablation for de novo AF in Ontario, Canada (2016-2022).
• Data collected included demographics, comorbidities, and key dates (diagnosis, referral, ablation).
• Primary outcome: composite of death and hospitalization/ED visit for AF, heart failure, or ischemic stroke within 1 year, analyzed using multivariable Cox models.

Main Results:

• Median diagnosis-to-ablation time was 718 days; median referral-to-ablation time was 221 days.
• 12.2% of patients experienced the composite endpoint within 1 year.
• Each monthly increase in diagnosis-to-ablation time was associated with a higher risk of the primary outcome (HR 1.02; 95% CI 1.01-1.02).
• Referral-to-ablation time did not significantly impact the primary outcome (HR 1.00; 95% CI 0.98-1.01).

Conclusions:

• Delays between AF diagnosis and ablation referral are linked to adverse postprocedural outcomes.
• These findings highlight opportunities for health system quality improvement in AF management.
• Focusing on reducing diagnosis-to-ablation intervals may enhance patient outcomes.