Early timing of ablation after diagnosis: a powerful way to reduce atrial fibrillation recurrence

FUNDING ACKNOWLEDGEMENTS: Type of funding sources: None. BACKGROUND: Diagnosis-to-ablation time (DAT) is a strong, modifiable predictor of AF recurrence after ablation. Referral time for ablation, and hence DAT became shorter over time. PURPOSE: To search for the shortest DAT still impacting outcome and to look at the evolution of the "DAT-AF recurrence" relation over time in a wide range of DAT. METHODS AND RESULTS: Two cohorts of 1000 AF patients (69% males, age 62±10 years) undergoing PVI (2006-2014 and 2017-2019) were followed for 3years. Clinical success, defined as freedom of documented AF was achieved in 61,7% of patients. Independent predictors of clinical success were age (HR=1,01; 95%CI 1,01-1,02; p 0,003), AF type (HR=0.54; 95%CI 0.46-0.63; p<0.0001), left atrial size (HR=1.05; 95%CI 1.03-1.06; p<0.0001), DAT (HR=1.00; 95%CI 1.00-1.00; p=0.001) and ablation technique (p=0.01) in multivariable-adjusted analysis. DAT decreased over time from 48±47 to 35±60months (p=0,001). Relation between the DAT (range 0-288months) and AF recurrence at 3 years was assessed in 1892 patients. The adjusted AF recurrence rate rises steeply from 27 to 40% in the first 36months. With further lengthening of the DAT the curve flattens following a less steep rise up to 45% until 90months. Further flattening occurs after a DAT of 90months. CONCLUSION: The AF recurrence rate starts to rise immediately after diagnosis and demonstrates a linear relation over time with increasing DAT times, most pronounced in the first 3 years after diagnosis and flattening thereafter. Our data advocate for ‘as early as possible’ PVI planning following diagnosis of AF to improve outcome. [Figure: see text]