Atrial fibrillation recurrence rates after ablation in relation to the diagnosis-to-intervention time

Background:
Atrial fibrillation (AF) is a chronic progressive disorder and can be associated with increased risks of thromboembolism and heart failure. Pulmonary vein isolation (PVI) as initial rhythm therapy may modify the pathogenic mechanism and may result in less AF recurrences.

Hypothesis:

A short diagnosis-to-intervention time is related to a reduction in AF recurrence.

Methods:
Patients with symptomatic AF undergoing their first PVI in our tertiary-center were retrospectively analyzed. Baseline clinical parameters, procedural parameters and follow-up data were collected. Different diagnosis-to-intervention times were related to AF recurrences.

Results:
Of 218 patients (67 ± 1 years, 61% male), the diagnosis to intervention time was <3 months in 51 (23%), 3-12 months in 69 (32%) and >12 months in 98 (45%). Most patients had paroxysmal AF (n=149, 66%). Further baseline characteristics (age, body-mass index, EHRA score, arterial hypertension, type 2 diabetes etc.) and procedural characteristics (procedure time, radiation dose etc.) were similar between the groups (data not shown). Diagnosis-to-intervention time was similar in patients with paroxysmal and persistent AF in the group with <3 months (26% vs. 21%), 3-12 months (32% vs. 27%) and >12 months (42% vs. 52%, P=0.38 Chi-Square-Test).
One-hundred fifty-eight patients had a follow-up over a time period of 358 ± 305 days. Of those, AF recurred in 45 (28%) patients. AF recurrence was similar in patients with diagnosis-to-intervention time of <3 months (n=13, 29%), 3-12 months (n=14, 31%) and >12 months (n=18, 40%; P=0.45 Log-Rank-Test; Figure).

Conclusions:
This single-center study showed no difference in AF recurrence in patients undergoing their first PVI with an ultra-short (<3 months), short (3-12 months) or long (>12 months) diagnosis-to-intervention time. Further studies with larger patient numbers are needed to confirm this hypothesis.