B-PO04-110 IMPACT OF A DEDICATED ATRIAL FIBRILLATION CLINIC ON DIAGNOSIS-TO-ABLATION TIME

Abstract

Outcomes following catheter ablation for atrial fibrillation (AF) improve as the diagnosis-to-ablation time (DAT) shortens. Use of a protocol based integrated care model through a dedicated Atrial Fibrillation Clinic (AFC) may serve to standardize treatment pathways and decrease DAT. Systematic risk-factor-modification (RFM) when built into these pathways can further improve the long-term success of catheter ablation. To evaluate the DAT for patients with AF referred from an AFC versus a conventional Electrophysiology Clinic (EC). Retrospective analysis was completed in consecutive patients undergoing index AF ablation from January 2019 to December 2019 at Riverside Methodist Hospital with minimum one year follow-up. Patients were categorized based off their referral source (AFC vs EC) and where the initial visit following index diagnosis occurred (AFC vs EC). A total of 182 patients (mean age 65±11 years, 116 [64%] male) were reviewed. The mean ejection fraction was 57±10% and 133 patients (73.1%) had paroxysmal AF. Patients referred from the AFC (21%) had a median DAT of 342 days (IQR, 125-855) compared to patients referred from EC (79%) with a median DAT of 813 days (IQR, 241-1444; P = 0.01). Patients with the index visit following AF diagnosis occurring in the AFC (9%) had significantly shorter median DAT when compared to EC (91%) (127 days [IQR, 95-188] compared to 789 days [IQR, 253-1503]; P = 0.002). Significantly higher number of patients underwent RFM counseling in the AFC (95% vs 40%; P < 0.00001), and referred for sleep apnea screening as clinically indicated (50% vs 20%; P = 0.003). There were no significant differences between the AFC and the EC patients with respect to antiarrhythmic drug use, type of AF (paroxysmal and persistent), BMI, LA dimension, and AF recurrence or time to recurrence after ablation. Patients referred from a dedicated AFC have shorter DAT than patients referred from a standard EC. Diagnosis to ablation time is further decreased if an index visit following diagnosis occurs in an AFC. Patients in an AFC are more likely to be referred for sleep apnea evaluation and receive documented RFM counseling. Longer term follow-up is recommended to assess the durable benefit of these interventions.