Early Ablation leads to better Outcome in Patients < 55 Years with Persistent Atrial Fibrillation

N. Erhard (München)¹, F. Bahlke (München)¹, B. Neuner (Berlin)², M.-A. Popa (München)³, H. Krafft (München)³, E. Abdiu (Erfurt)⁴, F. Bourier (Mallersdorf-Pfaffenberg)¹, M. Kottmaier (Neusäß)⁵, T. Reents (München)¹, C. Lennerz (München)¹, M. Telishevska (München)³, S. Lengauer (München)³, G. Heßling (München)⁶, I. Deisenhofer (München)³, F. Englert (München)^3
1Deutsches Herzzentrum München Klinik für Herz- und Kreislauferkrankungen München, Deutschland; ²Department of Anesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin Berlin, Deutschland; ³Deutsches Herzzentrum München Elektrophysiologie München, Deutschland; ⁴Helios-Klinikum Erfurt 3. Medizinische Klinik – Kardiologie Erfurt, Deutschland; ⁵Kardiologische Gemeinschaftspraxis Neusäß, Deutschland; ⁶Deutsches Herzzentrum München Klinik für Herz- und Kreislauferkrankungen, Abteilung der Elektrophysiologie München, Deutschland

Background

The question of optimal timing for catheter ablation of atrial fibrillation (AF) to achieve best outcomes remains a crucial clinical issue. As AF occurs less frequently in younger patients, data regarding Diagnosis-to-Ablation Time (DAT) is especially limited in patients under the age of 55 years with persistent AF. We therefore analyzed the temporal relationship between initial AF presentation and timing of catheter ablation in this cohort.

 

Methods and Results

We conducted a retrospective single-centre study of patients ≤ 55 years with persistent AF who underwent first-time catheter ablation at our center. The cohort was divided into patients that underwent catheter ablation after diagnosis of persistent AF within a DAT of ≤12 months and patients with a DAT of >12 months.

A total of 101 patients (median age 51 years; female n=19 (18.8%)) with persistent AF were included. Ablation was performed within 12 months (“early DAT”) in 51 patients and > 12 months (“late DAT”) in 50 patients.  Pulmonary vein isolation was performed using high-power short-duration (HPSD) radiofrequency ablation.

Median DAT was 5 months (1 – 12 months) in the early ablation group and 36 months (13-240 months) in the late ablation group. The median follow-up was 11.3 months (0.03 – 37.1 months). The rate of any atrial arrhythmia recurrence after a 30-day blanking period was significantly lower in the early DAT group (13/51 patients; 25.5%) as compared to the late DAT group (26/50 patients; 52.0%) (log rank test; p = 0.003). Catheter ablation performed > 12 months after the initial AF diagnosis was an independent predictor for the occurrence of any atrial arrythmia (OR: 2.58; (95%-CI: 1.32-5.07).

 

Conclusion

Early first-time catheter ablation (DAT ≤12 months) in patients ≤ 55 years with persistent AF is associated with a significantly lower rate of arrhythmia recurrence.