Abstract 13614: Increasing Time Between First Diagnosis of Atrial Fibrillation and Catheter Ablation Adversely Affects Long-Term Outcomes
Background: Many patients who develop atrial fibrillation (AF) will experience a worsening of their arrhythmia over time. Catheter ablation is an effective rhythm control strategy with favorable long-term outcomes. The optimal time to proceed with ablation during the disease course is unknown. Further, it is unknown if delays in treatment will negatively influence outcomes.
Methods: A total of 684 consecutive patients who underwent an AF ablation procedure that had long-term established care within an integrated health care system were evaluated. Recursive partitioning was used to determine categories associated with changes in risk from the time of first AF diagnosis (ICD-9 code: 427.31) to first AF ablation: 1: 30-180 (n=187), 2: 181-545 (n=116), 3: 546-1825 (n=186), 4: >1825 (n=195) days). Outcomes evaluated include 1 year AF recurrence, stroke, heart failure hospitalization, and death.
Results: With increasing time to treatment, patients were older (1: 63.7±11.1, 2: 62.6±11.8, 3: 66.4±10.2, 4: 67.6±9.70, p<0.0001) and had more hypertension (1: 64.7%, 2: 82.8%, 3: 74.7%, 4: 80.0%, p=0.001). There was no differences in AF subtypes between groups. For each increase strata of time increase, there was a direct increase of 1 year AF recurrence and/or need for long-term antiarrhythmics (Figure, p-trend=0.03). After adjustment, clinically significant differences in risk of recurrent AF were found when compared to the 30-180 day time category: 181-545: odd ratio(OR)=1.38, p=0.25; 546-1825: OR=1.62, p=0.05; and >1825: OR=1.58, p=0.06. No differences were observed in stroke or heart failure hospitalization among the groups. Death rates were higher in the most delayed group (1: 3.2%, 2: 4.3%, 3: 4.3%, 4: 11.8%, p-trend=0.001)
Conclusions: Delays in treatment with catheter ablation impact procedural success rates independent of temporal changes to the AF subtype at ablation. These data suggest catheter ablation should be considered early in the AF disease process.
- © 2012 by American Heart Association, Inc.