Abstract
BackgroundCatheter ablation (CA) has emerged as an effective treatment for symptomatic atrial fibrillation (AF). However practice patterns and patient factors associated with referral for CA within the first 12 months after diagnosis are poorly characterized. This study examined overall procedural trends and factors predictive of catheter ablation for newly-diagnosed atrial fibrillation in a young, commercially-insured population.MethodsA large nationally-representative sample of patients age 20 to 64 from years 2010 to 2016 was studied using the IBM MarketScan® Commercial Database. Patients were included with a new diagnosis of AF in the inpatient or outpatient setting with continuous enrollment for at least 1 year pre and post index visit. Patients were excluded if they had prior history of AF or had filled an anti-arrhythmic drug (AAD) in the pre-index period.ResultsEarly CA increased from 5.0% in 2010 to 10.5% in 2016. Patients were less likely to undergo CA if they were located in the Northeast (OR: 0.80, CI: 0.73–0.88) or North Central (OR: 0.91, CI: 0.83–0.99) regions (compared with the West), had higher CHA2DS2-VASc scores, or had Charlson Comorbidity Index (CCI) score of 3 or greater (OR: 0.61; CI: 0.51–0.72).ConclusionsCA within 12 months for new-diagnosed AF increased significantly from 2010 to 2016, with most patients still trialed on an AAD prior to CA. Patients are less likely to be referred for early CA if they are located in the Northeast and North Central regions, have more comorbidities, or higher CHA2DS2-VASc scores.
Highlights
Catheter ablation (CA) has emerged as an effective treatment for symptomatic atrial fibrillation (AF)
Several randomized controlled trials have sought to assess the effectiveness of CA as a first-line therapy for AF and found CA resulted in decreased AF burden and improved subjective quality of life compared to anti-arrhythmic drug (AAD) [7,8,9,10]
These studies have not addressed the optimal timing of CA, a prospective study showed that shorter duration between AF diagnosis and CA reduced rate of AF recurrence and adverse cardiac remodeling, using NT-proBNP and left atrial size as surrogate measures [12]
Summary
Catheter ablation (CA) has emerged as an effective treatment for symptomatic atrial fibrillation (AF). There are several ongoing clinical trials to assess the safety and efficacy of early ablation for AF in patients who have not been treated with AADs (NCT03118518, NCT02686749). These studies have not addressed the optimal timing of CA, a prospective study showed that shorter duration between AF diagnosis and CA reduced rate of AF recurrence and adverse cardiac remodeling, using NT-proBNP and left atrial size as surrogate measures [12]. Many US payer-based guidelines mandate treatment with an antiarrhythmic drug prior to referral for catheter ablation, which may delay time to CA and reduce its long-term effectiveness
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