Diagnosis‐to‐ablation time in atrial fibrillation: A modifiable factor relevant to clinical outcome. (6th June 2019)

• Record Type: Journal Article
• Authors: Bisbal, Felipe; Alarcón, Francisco; Ferrero‐De‐Loma‐Osorio, Angel; González‐Ferrer, Juan Jose; Alonso‐Martín, Concepción; Pachón, Marta; Vallés, Ermengol; Cabanas‐Grandío, Pilar; Sanchez, Manuel; Benito, Eva; Sarrias, Axel; Ruiz‐Granell, Ricardo; Pérez‐Villacastín, Julián; Viñolas, Xavier; Arias, Miguel Angel; Martí‐Almor, Julio; García‐Campo, Enrique; Fernández‐Lozano, Ignacio; Villuendas, Roger; Mont, Lluís
• Is Part Of: Journal of cardiovascular electrophysiology. Volume 30:Number 9(2019)
• Page Start: 1483
• Page End: 1490
• Publication Date: 2019-06-06
• Subjects: ablation -- atrial fibrillation -- pulmonary vein isolation -- risk prediction; Blood vessels -- Physiology -- Periodicals; Electrophysiology -- Periodicals; Heart -- Physiology -- Periodicals; 612.1
• DOI: 10.1111/jce.14000
• Languages: English
• ISSNs: 1045-3873

Abstract

Abstract: Introduction: Recurrences after atrial fibrillation (AF) ablation are still common. Among the reported clinical and imaging predictors of recurrences, diagnosis‐to‐ablation time (DAT) has been defined as a predictor of ablation outcome in single‐center studies. We aimed to validate DAT in a multicenter real‐life cohort. Methods: This was a multicenter study including consecutive patients undergoing first paroxysmal and persistent AF ablation with radiofrequency or cryoballoon catheters during 2013. Cox proportional hazard regression models were performed to identify predictors of recurrence. Results: In total, 309 patients were included across nine centers (71% men, 57 ± 10 years old, 46% with hypertension, and 66% with CHA2 DS2 ‐VASc ≤ 1). Most patients had paroxysmal AF (67%) and underwent radiofrequency ablation (68%) with a median DAT of 51 (43) months. Patients with DAT ≤ 1 year (16.6%) were less likely to have repeat procedures (4% vs 18%; P = .017). The adjusted proportional hazards Cox model identified hypertension ( P = .005), heart failure ( P = .011), nonparoxysmal AF ( P = .038), DAT > 1 year ( P = .007), and LA diameter ( P = .026) as independent predictors for AF recurrence. DAT > 1 year was the only modifiable factor independently associated with recurrence (HR 4.2 [95% CI, 1.5‐11.9]) Conclusion: Diagnosis‐to‐ablation time is a modifiable factor independently associated with recurrent arrhythmia and repeat ablation after first AF ablation. An early intervention strategy during the first year from AF diagnosis might improve outcomes.