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Don"t Wait to Ablate AF: Time Since Diagnosis Affects Success

The length of time between diagnosis of persistent atrial fibrillation (AF) and catheter ablation has a significant impact on the procedure"s success, in that the longer the interval, the worse the outcomes, suggests an analysis from a single but highly experienced center.

Once AF has been present a long time, especially in patients with persistent AF, "there is a lot of remodeling, scar formation, and fibrosis in the atrium. And once there is fibrosis and scarring, outcomes are really much worse than in patients who have AF but healthy atria," said senior author Dr Oussama Wazni (Cleveland Clinic Foundation, OH)."In this paper we found the sooner, the better," he said. "If a patient has persistent AF and the medications are not working or the patient isn"t tolerating the medication well, physicians should not waste too much time with medicines and refer patients to specialized centers where experts can deal with the problem."

The study, published online January 13, 2016 in Circulation: Arrhythmia and Electrophysiology with Dr Ayman A Hussein (Cleveland Clinic) as lead author, was based on a population of patients undergoing radiofrequency ablation for recurrent symptomatic AF from 2005 to 2012 who were enrolled in the center"s data registry. They had been followed with scheduled clinical visits and a 12-lead ECG at 3, 6, and 12 months and on a yearly basis thereafter. The current analysis included 1241 patients with persistent AF and no prior AF ablation or cardiac surgery.

Adjusted Hazard Ratio (95% CI) for Recurrence of AF, by Time Since Diagnosis, in 2 Years After Ablation

Quartile

HR (95% CI)

1 (≤1 y)

Reference

2 (1.1–3.0 y)

 2.12 (1.43–3.20)

3 (3.1–6.5 y)

 2.32 (1.59–3.47)

4 (>6.5 y)

 2.44 (1.68–3.65)

P<0.0001 quartile 4 vs quartile 1

http://www.medscape.com/viewarticle/857400