Delayed AF catheter ablation could mean worse outcomes

Delaying catheter ablation treatment after a diagnosis of atrial fibrillation (AF) may lead to a worse prognosis, according to a study published in the September issue of Heart Rhythm. Researchers found that delayed treatment was associated with higher risk of AF recurrence, death and heart failure hospitalization.

Catheter ablation effectively brings rhythms under control and outcomes are normally favorable, but “the optimal time to proceed with ablation during the disease course remains unknown,” wrote the researchers, led by T. Jared Bunch, MD, of Intermountain Medical Center in Murray, Utah.

They followed more than 4,500 patients who were long-time patients of the Intermountain Healthcare system who underwent an AF ablation procedure. The average follow-up time was about three years. The time between AF diagnosis and first ablation ranged from 30 days to more than five years. The primary long-term outcome was AF recurrence at one year.

They analyzed the outcomes based on four separate time intervals: 30 to 180 days, 181 to 545 days, 546 to 1825 days and more than 1825 days.

In general, the delayed patients were older and more hypertensive. The researchers also found that for each interval of time increase, there was a one-year increase in the rate of AF recurrence (30 to 180 days, 19.4 percent; 181 to 545 days, 23.4 percent; 546 to 1825 days, 24.9 percent; more than 1825 days, 24 percent).

There were no significant differences in terms of one-year stroke occurrence between the time groups. However, the risks of death and heart failure hospitalization were higher in the groups with the biggest delays.

“[A]s the primary objective of the study, delays in treatment of AF by catheter ablation over time reduce procedural success,” the authors wrote.  “Additionally, AF-related outcomes such as heart failure and death tend to be worse with delays in rhythm management compared to those of patients treated more early.”

Treating AF early and aggressively, they continued, can lead to better disease progression outcomes.

“These data suggest that ablation should be considered very early in AF disease management.”