Abstract 4369795: Impact of Diagnosis-to-Ablation Time on Clinical Outcomes in Patients with Atrial Fibrillation and Pre-Existing Heart Failure after Catheter Ablation: A US Retrospective Cohort Analysis

Background: Atrial fibrillation (AF) and heart failure (HF) often coexist. However, the optimal timing of catheter ablation for AF in patients with pre-existing HF remains uncertain. Purpose: This study aims to assess the impact of diagnosis-to-ablation time (DAT) on clinical outcomes in patients with AF and pre-existing HF who underwent their first catheter ablation. Methods: This study utilized the TriNetX database (January 2016 to April 2022). We identified 3,622 adult patients (≥ 18 years) with AF and pre-existing HF who underwent their first catheter ablation. Our primary outcome was the recurrence of AF 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 1,761 patients with DAT < 1 year, 976 patients with DAT 1–3 years, and 885 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: 1.421, 95% CI [1.271, 1.588], p < 0.001). However, DAT > 3 years was significantly associated with an even greater risk of AF recurrence (HR: 1.768, 95% CI [1.583, 1.975], p < 0.001). Additionally, compared to DAT < 1 year, DAT 1–3 years was significantly associated with an increased risk of acute HF (HR: 1.195, 95% CI [1.058, 1.350], p = 0.004). However, DAT > 3 years was significantly associated with an even greater risk of acute HF (HR: 1.233, 95% CI [1.088, 1.396], p = 0.002). Moreover, compared to DAT < 1 year, both DAT 1–3 years and DAT > 3 years were significantly associated with an increased risk of bleeding complications, cardiac-related hemodynamic instability, and all-cause hospitalizations. However, compared to DAT < 1 year, DAT > 3 years was significantly associated with an increased risk of all-cause mortality (HR: 1.363, 95% CI [1.094, 1.699], p = 0.006). However, there was no significant difference between early and delayed ablation in ischemic stroke and pericardial complications. Conclusion: Delayed ablation was significantly associated with an increased risk of AF recurrence, acute HF, bleeding complications, cardiac-related hemodynamic instability, all-cause hospitalizations, and all-cause mortality. However, there was no significant difference between early and delayed ablation in ischemic stroke and pericardial complications. This underscores the importance of early ablation within one year of AF diagnosis in patients with pre-existing HF.