Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave., Room A202, Toronto, ON M4N 3M5, Canada.
Temerty Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON M5S 1A8, Canada.
Europace. 2023 May 19;25(5). doi: 10.1093/europace/euad074.
Atrial fibrillation (AF) is the most common cardiac rhythm disorder. Emerging evidence supporting the efficacy of catheter ablation in managing AF has led to increased demand for this therapy, potentially outpacing the capacity to perform this procedure. Mismatch between demand and capacity for AF ablation results in wait-times which have not been comprehensively evaluated at a population level. Additionally, the consequences of such delays in AF ablation, namely the risk of hospitalization or adverse events, have not been studied.
This observational cohort study included adults referred for catheter ablation to treat AF in Ontario, Canada, between 1 April 2016 and 31 March 2020. Wait-time was defined from referral to the earliest of ablation, death, off-list, or the study endpoint of 31 March 2022. The outcomes of interest included a composite of death, hospitalization for AF/heart failure, and emergency department visit for AF/heart failure. Our study cohort included 6253 patients referred for de novo AF ablation. The median wait-time for patients who received and who did not receive ablation was 218 days (IQR: 112-363) and 520 days (IQR: 270-763), respectively. Wait-time increased consistently for patients referred between October 2017 and March 2020. Mortality was rare, but significant morbidity was observed, affecting 19.2% of patients on the waitlist for AF ablation. Paroxysmal AF was associated with a statistically significant greater risk for adverse outcomes on the waitlist (HR 1.51, 95% CI 1.18-1.93).
Wait-times for AF ablation are increasing and are associated with significant morbidity.
心房颤动（AF）是最常见的心律失常。越来越多的证据支持导管消融治疗 AF 的疗效，这导致对这种治疗方法的需求增加，可能超过了进行该手术的能力。AF 消融的需求与能力之间的不匹配导致了等待时间，而这在人群水平上尚未得到全面评估。此外，AF 消融延迟的后果，即住院或不良事件的风险，尚未得到研究。
本观察性队列研究纳入了 2016 年 4 月 1 日至 2020 年 3 月 31 日期间在加拿大安大略省因 AF 接受导管消融治疗的成年人。等待时间定义为从转诊到消融、死亡、未列入名单或 2022 年 3 月 31 日研究终点的最早时间。感兴趣的结果包括死亡、因 AF/心力衰竭住院和因 AF/心力衰竭急诊就诊的复合事件。我们的研究队列包括 6253 名因新发 AF 消融而转诊的患者。接受和未接受消融的患者的中位等待时间分别为 218 天（IQR：112-363）和 520 天（IQR：270-763）。2017 年 10 月至 2020 年 3 月期间转诊的患者的等待时间持续增加。死亡率较低，但观察到显著的发病率，接受 AF 消融的等待名单中有 19.2%的患者出现这种情况。阵发性 AF 与等待名单上不良结果的风险显著增加相关（HR 1.51，95%CI 1.18-1.93）。
AF 消融的等待时间正在增加，并与显著的发病率相关。
