新規発症心房細動に対する早期 vs 遅延アブレーション：5年間の実臨床データ転帰
Jacob R Heath1, Sangwoo Han2, Ashraf Alzahrani3
1Department of Internal Medicine, University of Iowa, Iowa City, Iowa.
Background:
Updated guidelines recognize catheter ablation as a first-line therapy for symptomatic atrial fibrillation (AF). The optimal timing of catheter ablation following AF diagnosis remains uncertain.
Objective:
This study assessed the impact of diagnosis-to-ablation time (DAT) <1 year vs DAT ≥1 year on AF recurrence and adverse clinical outcomes.
Methods:
We queried the TriNetX Research Network for patients ≥18 years of age with a diagnosis of AF who underwent ablation between January 1, 2010, and June 30, 2019. Patients were stratified into cohorts based on DAT <1 year vs ≥1 year and matched using 1:1 propensity scores, resulting in 8403 patients in each cohort. The primary outcome was AF recurrence, defined as a composite of cardioversion, antiarrhythmic use, or re-ablation at 3 and 5 years, after a 3-month blanking period. Secondary outcomes included a composite of heart failure exacerbation, ischemic stroke, all-cause hospitalization, and mortality, along with individual components.
Results:
DAT <1 year was associated with significantly lower AF recurrence both at 3 years (adjusted odds ratio 0.68 [95% confidence interval: 0.64-0.72]; P < .001) and 5 years (adjusted odds ratio 0.68 [95% confidence interval: 0.64-0.72]; P < .001). At 3 years, all secondary outcomes were significantly reduced in the DAT <1 year group, except for incident cerebrovascular accident and mortality. At 5 years, all secondary outcomes were significantly reduced in the DAT <1 year group.
Conclusion:
Catheter ablation within 1 year of AF diagnosis is associated with reduced AF recurrence and major adverse clinical outcomes. These findings support early referral for catheter ablation.
