Abstract 4369471: Impact of Diagnosis-to-Ablation Time on Clinical Outcomes in Patients with Atrial Fibrillation after Catheter Ablation: A US Retrospective Cohort Analysis

Background: Current clinical guidelines underscore the importance of rhythm control using catheter ablation but lack guidance regarding the timing of atrial fibrillation (AF) ablation in relation to the diagnosis time. Purpose: This study aims to assess the impact of diagnosis-to-ablation time (DAT) on clinical outcomes in patients with AF who underwent their first catheter ablation. Methods: This study utilized the TriNetX database (January 2016 to April 2022). We identified 62,548 adult patients (≥18 years) with AF who underwent their first catheter ablation. Our primary outcome was the recurrence of AF at a three-year follow-up following a three-month blanking period. All outcomes were evaluated at three-year follow-up using the hazard ratio (HR) and 95% confidence interval (CI). Results: Our study included 32,449 patients with DAT < 1 year, 13,662 patients with DAT 1–3 years, and 16,437 patients with DAT > 3 years. Compared to DAT < 1 year, DAT 1–3 years was significantly associated with an increased risk of AF recurrence (HR: 1.326, 95% CI [1.285, 1.368], p < 0.001). However, DAT > 3 years was significantly associated with an even greater risk of AF recurrence (HR: 1.532, 95% CI [1.488, 1.576], p < 0.001). Compared to DAT < 1 year, both DAT 1–3 years and DAT > 3 years were significantly associated with an increased risk of ischemic stroke (HR: 1.395, 95% CI [1.274, 1.528], p < 0.001) and (HR: 1.400, 95% CI [1.285, 1.526], p < 0.001), respectively. Additionally, compared to DAT < 1 year, DAT 1–3 years was significantly associated with an increased risk of all-cause mortality (HR: 1.393, 95% CI [1.259, 1.541], p < 0.001). However, DAT > 3 years was significantly associated with an even greater risk of all-cause mortality (HR: 1.617, 95% CI [1.475, 1.772], p < 0.001). Moreover, compared to DAT < 1 year, both DAT 1–3 years and DAT > 3 years were significantly associated with an increased risk of new-onset heart failure, bleeding complications, pericardial complications, cardiac-related hemodynamic instability, and all-cause hospitalizations. Conclusion: Delayed ablation was significantly associated with an increased risk of AF recurrence, new-onset heart failure, ischemic stroke, bleeding complications, pericardial complications, cardiac-related hemodynamic instability, all-cause hospitalizations, and all-cause mortality. This underscores the importance of early ablation within one year of AF diagnosis.