Impact of Diagnosis to Ablation Time on Recurrence of Atrial Fibrillation and Clinical Outcomes After Catheter Ablation: A Systematic Review and Meta-Analysis With Reconstructed Time-to-Event Data.
Ahmed Mazen Amin, Hossam Elbenawi, Ubaid Khan, Omar Almaadawy, Mustafa Turkmani, Wael Abdelmottaleb, Mohammed Essa, Mohamed Abuelazm, Basel Abdelazeem, Zain Ul Abideen Asad, Abhishek Deshmukh, Mark S Link, Christopher V DeSimone
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引用次数: 0
Abstract
Background: Current clinical guidelines emphasize the significance of rhythm control with catheter ablation but lack guidance on the timing of atrial fibrillation (AF) ablation relative to the diagnosis time. We aim to investigate the latest evidence on the impact of diagnosis to ablation time (DAT) on clinical outcomes after AF ablation.
Methods: We searched PubMed, Web of Science, Scopus, Embase, and Cochrane Central Register of Controlled Trials through August 2024. Pairwise, prognostic, and reconstructed time-to-event data meta-analyses were conducted using R V. 4.3.1. Our primary end point was time to first AF recurrence, with secondary end points of all-cause mortality, tamponade, stroke, and heart failure.
Results: Our cohort included 23 studies with 43 711 patients. Shorter DAT was significantly associated with reduced AF recurrence across both paroxysmal and persistent AF subgroups (P<0.01). There was a significant decrease in benefit for paroxysmal AF over time and a slight decrease in benefit for persistent AF over time. However, the benefit remained significant in both over time. DAT per year was significantly associated with a 10% increased risk of AF recurrence. Reconstructed Kaplan-Meier analysis showed that DAT >1 year was significantly associated with a 70% increased risk of AF recurrence in paroxysmal AF and 30% in persistent AF. DAT ≤1 year was significantly associated with decreased all-cause mortality (P<0.01) and showed a trend toward an association with a lower incidence of stroke (P=0.08). However, there was no significant difference in heart failure between DAT ≤1 year and DAT >1 year.
Conclusions: Early ablation is more beneficial in paroxysmal AF, with a notable decrease in benefit over time, while in persistent AF, the benefit remains significant but slightly decreases over time. Shorter DAT was significantly associated with decreased all-cause mortality and showed a trend toward an association with a lower incidence of stroke.
背景：目前的临床指南强调导管消融节律控制的重要性，但缺乏相对于诊断时间的房颤消融时间的指导。我们的目的是研究AF消融后诊断到消融时间（DAT）对临床结果影响的最新证据。方法：我们检索了PubMed， Web of Science, Scopus， Embase和Cochrane Central Register of Controlled Trials，截止到2024年8月。使用R V. 4.3.1进行两两、预后和重构时间-事件数据荟萃分析。我们的主要终点是首次房颤复发的时间，次要终点是全因死亡率、心包填塞、中风和心力衰竭。结果：我们的队列包括23项研究，43 711例患者。在阵发性和持续性房颤亚组中，较短的治疗时间与房颤复发减少显著相关(1年与阵发性房颤复发风险增加70%和持续性房颤复发风险增加30%显著相关。治疗时间≤1年与全因死亡率降低显著相关（PP=0.08）。然而，在治疗时间≤1年和治疗时间≤10年之间，心衰发生率无显著差异。结论：早期消融对阵发性房颤更有利，随着时间的推移益处显著下降，而对于持续性房颤，益处仍然显著，但随着时间的推移略有下降。较短的时间间隔与降低全因死亡率显著相关，并显示出与较低卒中发生率相关的趋势。注册：网址：https://www.crd.york.ac.uk/PROSPERO/；唯一标识符：CRD42024525542。
期刊介绍：
Circulation: Arrhythmia and Electrophysiology is a journal dedicated to the study and application of clinical cardiac electrophysiology. It covers a wide range of topics including the diagnosis and treatment of cardiac arrhythmias, as well as research in this field. The journal accepts various types of studies, including observational research, clinical trials, epidemiological studies, and advancements in translational research.
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