# Impact of diagnosis to ablation time on clinical outcomes in patients with atrial fibrillation: post hoc analysis of the CABANA trial

## TL;DR

This study examines how the timing of atrial fibrillation ablation affects clinical outcomes, finding that early ablation may reduce recurrence but not necessarily improve cardiovascular prognosis.

## Contribution

The study introduces a novel analysis of the temporal impact of ablation timing on post-ablation outcomes in atrial fibrillation patients.

## Key findings

- An L-shaped association was observed between diagnosis to ablation time and the primary outcome, with the lowest risk at 1 to 3 years.
- Early ablation reduced the risk of atrial fibrillation recurrence but did not significantly improve cardiovascular prognosis.
- The benefits of early ablation were more pronounced in patients who initially used antiarrhythmic drugs.

## Abstract

Current evidence is limited concerning the temporal impact of atrial fibrillation (AF) ablation timings on post-ablation outcomes.

Patients who experienced ablation in the CABANA trial were enrolled in our analysis. Diagnosis to ablation time (DAT) was calculated from the date when the initial AF episode was documented. The primary endpoint was a composite of death, disabling stroke, serious bleeding or cardiac arrest. Secondary end points included AF recurrence, all-cause mortality, and all-cause mortality or cardiovascular hospitalisation. Associations between DAT and post-ablation outcomes were evaluated by restricted cubic spline (RCS) curves based on Cox models.

Out of 1145 patients (median age 67.0 years, interquartile range (IQR) 61.0–72.0; 36.7% female) included, 538 (47.0%) underwent early ablation (DAT ≤ 1 year), including 242 (45.0%) who received very early ablation (DAT ≤ 90 days). The overall median DAT was 423 days (IQR 118–1473). The L-shaped association was observed between DAT and the primary outcome (P for non-linear = 0.034). The lowest point was located at a DAT of approximately 1 to 3 years. For AF recurrences, the RCS curve rose progressively with increasing DAT (P for non-linear = 0.062), showing a reduced risk when DAT was less than 1 year. Effects of early ablation on the primary outcome favoured patients with initial AAD use (HR 0.86, 95% confidence interval (CI) 0.43–1.73 vs. HR 2.20, 95% CI p-interaction = 0.045).

The benefits of earlier ablation in reducing AF recurrence might not equate to improvements in post-ablation cardiovascular prognosis. Timely treatment combining AADs and ablation may provide additional cardiovascular benefits.

ClinicalTrials.gov Identifier: NCT00911508.

The online version contains supplementary material available at 10.1186/s12916-026-04615-3.