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Diagnosis‐to‐ablation time in atrial fibrillation: A modifiable factor relevant to clinical outcome
Author(s) -
Bisbal Felipe,
Alarcón Francisco,
FerreroDeLomaOsorio Angel,
GonzálezFerrer Juan Jose,
AlonsoMartín Concepción,
Pachón Marta,
Vallés Ermengol,
CabanasGrandío Pilar,
Sanchez Manuel,
Benito Eva,
Sarrias Axel,
RuizGranell Ricardo,
PérezVillacastín Julián,
Viñolas Xavier,
Arias Miguel Angel,
MartíAlmor Julio,
GarcíaCampo Enrique,
FernándezLozano Ignacio,
Villuendas Roger,
Mont Lluís
Publication year - 2019
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/jce.14000
Subject(s) - medicine , atrial fibrillation , ablation , proportional hazards model , hazard ratio , cardiology , radiofrequency ablation , catheter ablation , cohort , heart failure , confidence interval
Recurrences after atrial fibrillation (AF) ablation are still common. Among the reported clinical and imaging predictors of recurrences, diagnosis‐to‐ablation time (DAT) has been defined as a predictor of ablation outcome in single‐center studies. We aimed to validate DAT in a multicenter real‐life cohort. Methods This was a multicenter study including consecutive patients undergoing first paroxysmal and persistent AF ablation with radiofrequency or cryoballoon catheters during 2013. Cox proportional hazard regression models were performed to identify predictors of recurrence. Results In total, 309 patients were included across nine centers (71% men, 57 ± 10 years old, 46% with hypertension, and 66% with CHA 2 DS 2 ‐VASc ≤ 1). Most patients had paroxysmal AF (67%) and underwent radiofrequency ablation (68%) with a median DAT of 51 (43) months. Patients with DAT ≤ 1 year (16.6%) were less likely to have repeat procedures (4% vs 18%; P = .017). The adjusted proportional hazards Cox model identified hypertension ( P = .005), heart failure ( P = .011), nonparoxysmal AF ( P = .038), DAT > 1 year ( P = .007), and LA diameter ( P = .026) as independent predictors for AF recurrence. DAT > 1 year was the only modifiable factor independently associated with recurrence (HR 4.2 [95% CI, 1.5‐11.9]) Conclusion Diagnosis‐to‐ablation time is a modifiable factor independently associated with recurrent arrhythmia and repeat ablation after first AF ablation. An early intervention strategy during the first year from AF diagnosis might improve outcomes.