Diagnosis to Ablation in Persistent AF: Any Time Can Be a Good Time to Ablate

Area of Science:

• Cardiology
• Electrophysiology
• Medical Research

Background:

• Nonrandomized studies suggest longer diagnosis-to-ablation time (DAT) correlates with worse outcomes in atrial fibrillation (AF).
• A prior randomized trial indicated no difference in AF recurrence with a 12-month ablation delay.

Purpose of the Study:

• To evaluate the impact of DAT on AF recurrence in patients undergoing catheter ablation for persistent AF.
• To analyze DAT's association with AF recurrence and quality of life post-ablation.

Main Methods:

• The CAPLA randomized clinical trial involved 334 patients with persistent AF.
• Patients were randomized to pulmonary vein isolation with or without posterior left atrial wall isolation.
• Follow-up was 12 months, with outcomes assessed after a 3-month blanking period.

Main Results:

• Median DAT was 28 months; patients were grouped into quartiles based on DAT.
• AF recurrence rates ranged from 36.9% (0-12 months DAT) to 56.8% (≥67 months DAT), with P=0.082.
• Longer DAT (≥67 months) was significantly associated with increased recurrence risk (HR: 1.607; P=0.048) on multivariable analysis.

Conclusions:

• Shorter DAT was linked to lower AF recurrence rates in persistent AF patients undergoing ablation.
• Despite statistical associations, differences in recurrence were modest, with all groups showing low AF burden.
• Significant improvements in quality of life were observed across all DAT quartiles.