Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada; Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.
ICES, Toronto, Canada.
Heart Rhythm. 2024 Sep;21(9):1477-1484. doi: 10.1016/j.hrthm.2024.04.043. Epub 2024 Apr 10.
Rhythm control is a cornerstone of atrial fibrillation (AF) management. Shorter time between diagnosis of AF and receipt of catheter ablation is associated with greater rates of therapy success. Previous work considered diagnosis-to-ablation time as a binary or categorical variable and did not consider the unique risk profile of patients after a referral for ablation was made.
The purpose of this study was to comprehensively assess the impact of diagnosis-to-ablation and referral-to-ablation time on postprocedural outcomes at a population level.
This observational cohort study included patients who received catheter ablation to treat AF in Ontario, Canada. Patient demographics, medical comorbidities, AF diagnosis date, ablation referral date, and ablation date were collected. The primary outcomes of interest included a composite of death and hospitalization/emergency department visit for AF, heart failure, or ischemic stroke. Multivariable Cox models assessed the impact of diagnosis-to-ablation and referral-to-ablation times on the primary outcome.
Our cohort included 7472 patients who received ablation for de novo AF between April 1, 2016, and March 31, 2022. Median [interquartile range] diagnosis-to-ablation time was 718 [399-1274] days and median referral-to-ablation time was 221 [117-363] days. Overall, 911 patients (12.2%) had the composite endpoint within 1 year of ablation. Increasing diagnosis-to-ablation time was associated with a greater incidence for the primary outcome (hazard ratio [HR]1.02; 95% confidence interval [CI] 1.01-1.02 per month). Increasing referral-to-ablation time did not impact the primary outcome (HR 1.00; 95% CI 0.98-1.01 per month).
Delays between AF diagnosis and ablation referral may contribute to adverse postprocedural outcomes and provide an opportunity for health system quality improvements.
节律控制是心房颤动（AF）管理的基石。AF 诊断与导管消融之间的时间越短，治疗成功率越高。以前的研究将诊断至消融时间视为二项或分类变量，并未考虑到消融转诊后患者的独特风险状况。
本研究旨在全面评估人群水平上诊断至消融和转诊至消融时间对术后结果的影响。
本观察性队列研究纳入了在加拿大安大略省接受导管消融治疗 AF 的患者。收集了患者的人口统计学资料、合并症、AF 诊断日期、消融转诊日期和消融日期。主要观察终点包括死亡和因 AF、心力衰竭或缺血性卒中而住院/急诊就诊的复合终点。多变量 Cox 模型评估了诊断至消融和转诊至消融时间对主要结局的影响。
我们的队列包括 7472 名新诊断为 AF 并于 2016 年 4 月 1 日至 2022 年 3 月 31 日期间接受消融治疗的患者。诊断至消融时间中位数（四分位距）为 718（399-1274）天，转诊至消融时间中位数为 221（117-363）天。总体而言，1 年内有 911 名患者（12.2%）发生了复合终点事件。诊断至消融时间的增加与主要结局的发生率增加相关（风险比[HR]1.02；95%置信区间[CI]1.01-1.02/月）。转诊至消融时间的增加并未影响主要结局（HR 1.00；95% CI 0.98-1.01/月）。
AF 诊断与消融转诊之间的延迟可能导致不良的术后结果，并为改善卫生系统质量提供机会。
