Early choice for catheter ablation reduced readmission in management of atrial fibrillation: Impact of diagnosis-to-ablation time. (15th September 2019)

• Record Type: Journal Article
• Authors: Kawaji, Tetsuma; Shizuta, Satoshi; Yamagami, Shintaro; Aizawa, Takanori; Komasa, Akihiro; Yoshizawa, Takashi; Kato, Masashi; Yokomatsu, Takafumi; Miki, Shinji; Ono, Koh; Kimura, Takeshi
• Is Part Of: International journal of cardiology. Volume 291(2019)
• Page Start: 69
• Page End: 76
• Publication Date: 2019-09-15
• Subjects: Atrial fibrillation -- Radiofrequency catheter ablation -- Diagnosis to ablation time; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2019.03.036
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: The impact of delays in the treatment with radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF) has not been well evaluated. The aim of this study was to investigate the impact of diagnosis-to-ablation time (DAT) on the long-term clinical outcomes after AF-RFCA. Methods: We enrolled 1206 consecutive patients undergoing first-time RFCA for AF. The study population was divided into 2 groups based on DAT: short (<3 years) (N = 675) and long (>3 years) (N = 531) DAT groups. Results: Mean follow-up duration was 5.0 ± 2.5 years. The 5-year event-free rates from recurrent atrial tachyarrhythmias after the first and second RFCAs were significantly higher in short DAT group than in long DAT group (60.2% versus 48.3%, log-rank P < 0.001; 83.2% versus 75.2%, log-rank P = 0.02, respectively), leading to reduced cardiovascular hospitalization in short DAT group. After adjusting baseline differences, short DAT was independently associated with lower arrhythmia recurrence rates after the first and second RFCAs (hazard ratio [HR] 0.72, 95% confidence interval [CI] 0.60–0.86 and HR 0.72, 95%CI 0.55–0.95, respectively). There were no significant differences between the 2 groups in the event-free rates from all-cause and cardiovascular deaths, heart failure hospitalization, and ischemic stroke. However, among patients with a history of heart failure or reduced left ventricular function, the event-free rate from heart failure readmission was significantly higher in short DAT group (85.0% versus 61.0%, P = 0.004). Conclusions: In the management of AF, early RFCA was associated with significantly lower arrhythmia recurrence compared with delayed RFCA, leading to reduced cardiovascular hospitalization, especially in heart failure patients. Highlights: Short diagnosis-to-ablation time (DAT) (<3 years) had higher arrhythmia-free rates after atrial fibrillation (AF) ablations. In the multivariate analysis, short DAT was independently associated with higher arrhythmia-free rates after AF ablations. The incidence of death, stroke, and heart failure was not significantly different between the short and long DAT groups. However, among heart failure patients, the risk of heart failure readmission was significantly lower in the short DAT group.