Optimal timing for atrial fibrillation patients to undergo catheter ablation.

Abstract

Background: The optimal timing of undergoing catheter ablation for patients with atrial fibrillation (AF) remains uncertain. We aimed to investigate the impact of diagnosis-to-ablation time (DAT) on AF recurrence and major adverse cardiovascular and cerebrovascular events (MACCE) following catheter ablation.

Methods: This study analyzed prospective observational data from a single center, including 2097 participants (59.98 ± 10.57 years, 62.7% male) undergoing AF ablation between January 2016 and December 2020. Patients were stratified by DAT: ≤ 1 year, > 1 to ≤ 3 years, and > 3 years. Cox proportional hazards and logistic regression analyses were used to identify predictors of AF recurrence and MACCE.

Results: During the 46.89 ± 16.46 months follow-up, AF recurs in 512 patients (24.6%). A longer delay per month is significantly associated with a higher recurrence of AF based on multivariable Cox regression analysis [Hazard Ratio (HR) 1.003 (95% CI: 1.001-1.005), p = 0.015]. This association remains consistent in patients with persistent AF (HR compared to DAT ≤ 1 year: 1.548 [95% CI: 1.139-2.102], p = 0.016), but not in those with paroxysmal AF. Left atrial diameter ≥40 mm and female are identified as independent predictors of AF recurrence. The overall impact of DAT on MACCE occurrence is not significant, with age and vascular disease being independent predictors.

Conclusions: Early catheter ablation is preferable for maintaining sinus rhythm, particularly in persistent AF. However, DAT dose not influence the incidence of MACCE. These findings endorse the paradigm shift towards early ablation.