Department of Cardiology Herlev-Gentofte University Hospital, University of Copenhagen Hellerup Denmark.
Bispebjerg and Frederiksberg Hospital Copenhagen Denmark.
J Am Heart Assoc. 2024 Apr 2;13(7):e032722. doi: 10.1161/JAHA.123.032722. Epub 2024 Mar 27.
Guidelines recommend prioritizing treatment with antiarrhythmic drugs before referral of patients with atrial fibrillation to ablation, delaying a potential subsequent ablation. However, delaying ablation may affect ablation outcomes. We sought to investigate the impact of duration from diagnosis to ablation on the risk of atrial fibrillation recurrence and adverse events.
Using Danish nationwide registries, all patients with first-time ablation for atrial fibrillation were identified and included from 2010 to 2018. Patients were divided into 4 groups by diagnosis-to-ablation time: <1.0 year (early ablation), 1.0 to 1.9 years, 2.0 to 2.9 years, and >2.9 years (late ablation). The primary end point was atrial fibrillation recurrence after the 90-day blanking period, defined by admission for atrial fibrillation, cardioversions, use of antiarrhythmic drugs, or repeat atrial fibrillation ablations. The secondary end point was a composite end point of heart failure, ischemic stroke, or death, and each event individually. The study cohort consisted of 7705 patients. The 5-year cumulative incidence of atrial fibrillation recurrence in the 4 groups was 42.9%, 54.8%, 55.9%, and 58.4%, respectively. Hazard ratios were 1.20 (95% CI, 1.07-1.35), 1.29 (95% CI, 1.13-1.47), and 1.40 (95% CI, 1.28-1.53), respectively, with the early ablation group as reference. The hazard ratio for the combined secondary end point was 1.22 (95% CI, 1.04-1.44) in the late ablation group compared with the early ablation group.
In patients undergoing ablation for atrial fibrillation, early ablation was associated with a significantly lower risk of atrial fibrillation recurrence. Furthermore, the associated risk of heart failure, ischemic stroke, or death was significantly lower in early-compared with late-ablation patients.
指南建议在将房颤患者转介消融治疗之前，优先使用抗心律失常药物进行治疗，从而延迟潜在的后续消融。然而，延迟消融可能会影响消融效果。我们旨在研究从诊断到消融的时间间隔对房颤复发和不良事件风险的影响。
使用丹麦全国性登记处，我们确定并纳入了 2010 年至 2018 年期间首次进行房颤消融的所有患者。根据诊断到消融的时间，患者被分为 4 组：<1.0 年（早期消融）、1.0 至 1.9 年、2.0 至 2.9 年和>2.9 年（晚期消融）。主要终点是 90 天空白期后的房颤复发，定义为因房颤、电复律、抗心律失常药物使用或重复房颤消融而入院。次要终点是心力衰竭、缺血性卒中和死亡的复合终点，以及每个单独的事件。研究队列包括 7705 名患者。4 组患者的 5 年房颤复发累积发生率分别为 42.9%、54.8%、55.9%和 58.4%。风险比分别为 1.20（95%CI，1.07-1.35）、1.29（95%CI，1.13-1.47）和 1.40（95%CI，1.28-1.53），早期消融组为参照。与早期消融组相比，晚期消融组复合次要终点的风险比为 1.22（95%CI，1.04-1.44）。
在接受房颤消融治疗的患者中，早期消融与房颤复发的风险显著降低相关。此外，与晚期消融患者相比，早期消融患者心力衰竭、缺血性卒中和死亡的相关风险显著降低。
