Abstract 14414: In Younger Patients Increasing Time Between First Diagnosis of Atrial Fibrillation and Catheter Ablation Significantly Impacts Long-term Outcomes
Background: Many patients who develop atrial fibrillation (AF) will experience a worsening of their arrhythmia over time. AF ablation remains the most aggressive rhythm control strategy, but the optimal timing remains unknown. Younger patients that have less cardiovascular comorbidities may benefit from an earlier, more aggressive rhythm control strategy.
Methods: A total of 4,535 consecutive patients who underwent an AF ablation procedure that had long-term established care within an integrated health care system were evaluated. First diagnosis of AF was determined through the system wide electronic medical records. Recursive partitioning was used to determine categories associated with changes in risk from the time of first AF diagnosis to first AF ablation. AF recurrence outcomes were compared by age strata (<60, 60-70, >70 years) for 4 time strata (Figure).
Results: With increasing time to treatment, patients on average were older (1: 63.7±11.1, 2: 62.6±11.8, 3: 66.4±10.2, 4: 67.6±9.7, p<0.0001) and had more hypertension (1: 53.0%, 2: 59.0%, 3: 53.8%, 4: 39.0%, p<0.0001). For each strata of time increase, there was a direct increase of 1 year AF recurrence (1: 19.4%, 2: 23.4%, 3: 24.9%, 4: 24.0%, p-trend = 0.02). Early ablation benefit was most notable in the younger group of patients (<60), particularly when comparing the last two time strata with the earlier strata (HR 1.40, p=0.06; HR 1.41, p=0.05). Very early ablation also benefited the older group (>70), although an interval benefit across all time strata was not seen (Figure).
Conclusions: Younger patients experience significantly better outcomes with an earlier ablation strategy after first diagnosis of AF compared to older patients.
- © 2013 by American Heart Association, Inc.