Diagnosis-to-Ablation Time and Atrial Arrhythmia Recurrence After Ablation

Diagnosis-to-ablation time (DAT) has emerged as a potential predictor of ablation outcomes in atrial fibrillation (AF). Limited evidence is available on the association of prolonged DAT, and existing studies are constrained by small sample sizes and methodological heterogeneity.

To evaluate whether DAT is associated with atrial arrhythmia recurrence following radiofrequency ablation (RFA) for AF.

In this cohort study, patients with AF undergoing de novo RFA from January 2018 to June 2023 in a large, multicenter, clinical practice registry were included. Data were analyzed in August 2024.

Available DAT and 1-year postablation follow-up.

Multivariable Cox regression was used to assess the association between DAT and recurrent atrial arrhythmia (post-blanking period).

A total of 3724 patients were included (1492 [40.1%] female; mean [SD] age, 67.0 [10.0] years; mean [SD] BMI, 31.0 [6.8]; and mean [SD] CHA2DS2-VASc score, 2.8 [1.5]). The median (IQR) DAT was 1 (0-4) year, and 2412 (64.8%) underwent RFA for paroxysmal AF. Compared with patients with DAT of less than 1 year, after adjusting for baseline characteristics and comorbidities, patients with DAT of 1 to 4 years had a 48% higher risk of all atrial arrhythmia recurrence (hazard ratio [HR], 1.48; 95% CI, 1.08-2.01; P = .01), and those with DAT greater than 5 years had a 110% increased risk (HR, 2.10; 95% CI, 1.46-3.02; P < .001).

In this cohort study of patients undergoing de novo RFA, longer DAT was associated with an increased risk of atrial arrhythmia recurrence at 1 year. These results suggest that delayed referral for ablation may be an important prognostic marker in contemporary clinical practice.