Impact of diagnosis-to-ablation time on atrial fibrillation recurrence: most pronounced in the first 3 years after diagnosis and clinically irrelevant thereafter

Abstract

Abstract Objectives To assess the impact of the diagnosis-to-ablation time (DAT) on AF recurrence in search of lower and upper DAT thresholds. Background DAT is a strong, modifiable predictor of atrial fibrillation (AF) recurrence after ablation. Whether this association holds any lower and/or upper limits is yet unknown. Methods A total of 2000 AF patients from two cohorts of 1000 consecutive patients each (69% males, age 62±10 years) undergoing pulmonary vein isolation (PVI) between 2005-2014 and 2017-2019 were followed for 3 years. Results Clinical success, defined as freedom of documented AF was achieved in 61.7% of the patients. Median DAT decreased over time from 36 (Q1-Q3: 12-72) months in the first cohort to 12 (Q1-Q3: 5-48) in the second (P<0.001). A multivariable Cox proportional hazards fitted model of AF recurrence rate in relation to DAT (range 0-288 months) demonstrated a steep rise in AF recurrence from 27 to 40% in the first 36 months (d%/dt=0.36), with a first hinge point at 36 months and a less steep rise to 45% until 90 months (d%/dt=0.09), with flattening beyond 90 months (d%/dt=0.026). Conclusions The association between DAT and AF recurrence has no lower limit (‘the shorter the better’) while little gain is to be expected beyond a DAT of 36 months (‘the longer the more clinically irrelevant’). Our data advocate for a PVI as early as possible, certainly within 3 years of AF diagnosis.3-year AF recurrence rate versus DAT