Delays in ablation after AF diagnosis increase mortality risk
A delay in time to catheter ablation after an atrial fibrillation diagnosis is associated with increased mortality risk as well as trends of increased risk for HF hospitalization and AF recurrence, researchers reported.
“Although catheter ablation has been demonstrated to be the most effective treatment for patients with concurrent AF and left ventricular dysfunction, few studies have been conducted regarding the optimal timing for ablation after diagnosis of AF,” T. Jared Bunch, MD, director of heart rhythm research at the Intermountain Medical Center Heart Institute and medical director for heart rhythm services for the Intermountain Healthcare System, Salt Lake City, and colleagues wrote in the study background. “The EAST-AFNET 4 randomized controlled trial demonstrated that early rhythm control therapy (within 12 months after AF diagnosis) was beneficial in patients recently diagnosed with AF; however, it did not distinguish between early rhythm control with pharmaceuticals and catheter ablation.”
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Bunch and colleagues analyzed data from 9,979 patients who underwent catheter ablation for AF with 1 year of follow-up within the Intermountain Healthcare system. Researchers stratified patients by the presence of structural disease by ejection fraction of 35% or less (n = 1,024) and EF greater than 35% (n = 8,955). Patients were also stratified based upon time from initial AF diagnosis until undergoing catheter ablation: 30 to 180 days (n = 2,689); 181 to 545 days (n = 1,747); 546 to 1,825 days (n = 2,941); and more than 1,825 days (n = 2,602).
The findings were published in the Journal of Cardiovascular Electrophysiology.
Within the cohort, the mean time from AF diagnosis to first ablation was 3.5 years.
Among patients with an EF greater than 35%, delays in treatment increased risk for death with time. Compared with undergoing ablation 30 to 180 days after AF diagnosis, HRs for all-cause death were 2.02 for those with a delay of 181 to 545 days (95% CI, 1.38-2.96; P < .0001), 2.62 for a delay of 546 to 1,825 days (95% CI, 1.87-3.65; P < .0001) and 4.39 for a delay of more than 1,825 days (95% CI, 3.11-6.21; P < .0001).
Similarly, for patients with an EF of 35% or less, treatment delays also increased risk for death. Compared with undergoing ablation 30 to 180 days after AF diagnosis, HRs for all-cause death were 2.07 for those with a delay of 181 to 545 days (95% CI, 1.06-4.04; P = .03), 1.93 for a delay of 546 to 1,825 days (95% CI, 1.04-3.58; P = .04) and 3.77 for a delay of more than 1,825 days (95% CI, 2-7.1; P < .0001).
Researchers also observed in those with treatment delays an increased risk for HF hospitalization and for AF recurrence across most time and EF groups.
“These data in aggregate favor early use of ablation for AF in patients with HF,” the researchers wrote. “The particular benefit in patients with an EF > 35% suggests the need for prospective randomized control trial data in this population in patients with HF to assess to role of ablation as a first-line therapy.”
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