Background:
Early rhythm-control therapy in patients with atrial fibrillation (AF) has been associated with improved cardiovascular outcomes. Cornerstone in AF therapy is catheter ablation which reduces AF recurrences and improves quality of life. The aim of the study was to determine the impact of early (within 1 year after initial AF diagnosis) compared to late AF ablation, on long term outcome.
Methods:
Two hundred and nineteen consecutive patients (41% female; 64±9.7 years old; left ventricular ejection fraction 59±8%; LA diameter 48±5.5mm; CHA2DS2-Vasc 2.7±1.4; BMI 30.7±5,7; 48% paroxysmal AF) who underwent AF ablation (pulmonary vein isolation only in 84% of cases) were included in the study. Patients were grouped as early treated (n=113) if the procedure was performed within 1 year after the first AF episode, and as delayed treated (n=106) if admitted for ablation after more than 1 year. We determined any AF or atrial tachycardia (AT) recurrence during a follow-up of 12 months using implantable loop recorder (ILR).
Results:
The mean time from the first arrhythmic episode to ablation procedure was 163 days in early treated patients and 2554 days in the delayed treatment group. Other patient characteristics and ablation strategies were similar between the groups. During follow-up, 103/219 patients (47.2%) suffered from AF/AT recurrence after the 90-day blanking period. Freedom of AF/AT was higher in the early treatment group compared with the delayed treatment group (58.3% vs 41.7%, respectively; P=0.045).
Conclusion:
Our long-term follow-up data using ILR argue the importance of an early ablation strategy in AF patients. Recurrences of any atrial arrhythmias were significantly lower in patients ablated within 1 year of AF diagnosis compared to later ablation.