Abstract 17316: Association Between Time From Atrial Fibrillation Diagnosis to First Catheter Ablation With Long-Term Clinical Outcomes: Insights From the UC San Diego AF Ablation Registry

Abstract

Background: While the optimal timing for atrial fibrillation (AF) ablation is unknown, several studies have reported increased freedom from atrial arrhythmias among persistent AF patients with shorter time to first ablation after diagnosis. However, these studies have only examined two-year post-ablation outcomes. Methods: We performed a retrospective study of all patients who underwent first-time radiofrequency catheter ablation enrolled in the UC San Diego AF Ablation Registry. The primary outcome was freedom from atrial arrhythmias on or off antiarrhythmic drugs (AAD). Median follow-up duration was 3.9 (0.4 - 6.8) years. Patients were categorized into quartiles by time from diagnosis of AF to first ablation (0-250, 251-855, 856-2200, and >2200 days respectively). Results: Among 534 total patients, the median diagnosis-to-ablation time was 2.3 years (25th-75th percentiles 0.7-6.0 years). At 5 years post-ablation, freedom from atrial arrhythmia significantly decreased as time to ablation increased in both paroxysmal and persistent AF (Parox: 50.5%, 46.8%, 35.6%, 36.6%, p-trend=0.042; Persist: 36.9%, 23.6%, 16.3%, and 22.6%, p-trend<0.01 for 1st, 2nd, 3rd, and 4th quartiles respectively). After adjustment, clinically significant differences in freedom from atrial arrhythmia were found in both paroxysmal and persistent AF when compared to the 0-250 day time category: 250-855: Adjusted Hazard Ratio (AHR)=1.11, p=0.69 (parox), AHR=1.48, p=0.26 (persist); 856-2200: AHR=1.24, p=0.40 (parox), AHR=2.16, p=0.04 (persist); and >2200: AHR=1.69, p=0.03 (parox), AHR=2.73, p<0.01 (persist). Among all patients, all-cause mortality increased as first ablation was delayed beyond 2.3 years after diagnosis (AHR 3.05, p = 0.047). Conclusion: In this registry analysis, delayed time to first ablation after diagnosis of both persistent and paroxysmal AF was associated with higher rates of atrial arrhythmia recurrence and all-cause mortality after 5 years.