Correlation Between Catheter Ablation Timing and the Duration of Atrial Fibrillation History on Arrhythmia Recurrence in Patients with Paroxysmal Atrial Fibrillation: A Systematic Review and Meta-Analysis

TL;DR

This study finds that earlier catheter ablation for atrial fibrillation leads to better outcomes, especially in patients with paroxysmal AF.

Contribution

The study provides new evidence on the optimal timing of catheter ablation for atrial fibrillation.

Findings

Early ablation resulted in a 29.8% recurrence rate, compared to 39.5% for delayed ablation.

Cryoablation had a lower recurrence rate (27.3%) than radiofrequency ablation (44.5%).

In paroxysmal AF patients, recurrence rate increased with longer diagnosis-to-ablation time.

Abstract

Background: Atrial fibrillation (AF) is the most common sustained arrhythmia. AF catheter ablation (CA) is superior to antiarrhythmic drugs (AAD) therapy in maintaining sinus rhythm. However, not much is known regarding the optimal timing of the ablation. Methods: A comprehensive literature search was conducted using PubMed, Embase, and Scopus, focusing on studies published from 2013 until 2022 and including both observational studies and randomized controlled trials (RCTs) with patients undergoing ablation for symptomatic paroxysmal or persistent AF using radiofrequency, cryoablation, or both approaches, studies that reported diagnosis-to-ablation time (DAT), a follow-up period, AF recurrence, or AF burden. Studies that included a surgical ablation, a hybrid ablation approach, or an ablation for arrhythmias other than AF were excluded. Left atrial diameter and ejection fraction (EF) were assessed. Results: Ten studies were selected out of 1387 identified records. After a follow-up period of one year, the early ablation subgroup had a lower mean AF recurrence rate (29.8%) compared to that of the delayed ablation subgroup (39.5%). The median AF recurrence rate was in the radiofrequency ablation group (44.5%), in the cryoablation group (27.3%). In studies that included paroxysmal AF patients exclusively, the AF recurrence rate was directly proportional to the DAT. Conclusions: Our results suggest that DAT correlates with a recurrence rate at one year following AF CA, and that the shorter the DAT the better the outcome, particularly in paroxysmal AF population.

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