Early choice for catheter ablation reduced readmission in management of atrial fibrillation: Impact of diagnosis-to-ablation time

Kawaji, Tetsuma; Shizuta, Satoshi; Yamagami, Shintaro; Aizawa, Takanori; Komasa, Akihiro; Yoshizawa, Takashi; Kato, Masashi; Yokomatsu, Takafumi; Sato, Miki; Ono, Koh; Kimura, Takeshi

doi:10.1016/j.ijcard.2019.03.036

Cited by 33 publications

(33 citation statements)

References 20 publications

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“…After assessing eight full‐text for eligibility, we excluded two because of (a) no outcome of DTAT on the recurrence of AF and (b) outcome cannot be used for meta‐analysis due to different reporting. We included six studies in the qualitative synthesis and six studies in meta‐analysis (Figure ; Table ) . Five studies were prospective cohorts, and one study was a retrospective cohort.…”

Section: Resultsmentioning

confidence: 99%

“…Paroxysmal AF occasionally (10%‐20%) progress to persistent AF and probably, considering the delay in that 10%‐20% patients, DTAT is still a significant predictor of AF recurrence . Kawaji et al stated that the risk for ischemic stroke and transient ischemic attack increased with DTAT, half of the events occurred after the diagnosis of AF, and it was found that the prevalence of stroke is higher in those with DTAT >3 years compared to <3 years, this means that DTAT also possibly affect cardiovascular outcome . Kawaji et al also showed the rate of heart failure hospitalizations was significantly lower in those with short DTAT further emphasizing the importance of DTAT in outcomes other than AF recurrence .…”

Section: Discussionmentioning

confidence: 99%

“…Kawaji et al stated that the risk for ischemic stroke and transient ischemic attack increased with DTAT, half of the events occurred after the diagnosis of AF, and it was found that the prevalence of stroke is higher in those with DTAT >3 years compared to <3 years, this means that DTAT also possibly affect cardiovascular outcome . Kawaji et al also showed the rate of heart failure hospitalizations was significantly lower in those with short DTAT further emphasizing the importance of DTAT in outcomes other than AF recurrence . The cause of heterogeneity in the DTAT >3 years is Kawaji et al study which compared <3 years vs >3 years DTAT, as opposed to the other study included the meta‐analysis which compared >3 years with <1 year DTAT; however, the results did not differ much upon removal of the study on sensitivity analysis.…”

Section: Discussionmentioning

confidence: 99%

“…We included six studies in the qualitative synthesis and six studies in meta-analysis ( Figure 1; Table 1). [8][9][10][11][12][13] Five studies were prospective cohorts, and one study was a retrospective cohort. There was a total of 3548 patients from six studies.…”

Section: Re Sultsmentioning

confidence: 99%

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Longer diagnosis‐to‐ablation time is associated with recurrence of atrial fibrillation after catheter ablation—Systematic review and meta‐analysis

Pranata

Chintya

Raharjo

et al. 2019

Journal of Arrhythmia

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Background Diagnosis‐to‐ablation time (DTAT) has been postulated to be one of the predictors of atrial fibrillation (AF) recurrence, and it is a “modifiable” risk factor unlike that of many electrocardiographic or echocardiographic parameters. This development may change our consideration for ablation. In this systematic review and meta‐analysis, we aim to analyze the latest evidence on the importance of DTAT and whether they predict the AF recurrence after catheter ablation. Methods We performed a comprehensive search on topics that assess diagnosis‐to‐ablation time (DTAT) and AF recurrence from inception up until August 2019 through PubMed, EuropePMC, Cochrane Central Database, and http://ClinicalTrials.gov. Results There was a total of 3548 patients from six studies. Longer DTAT was associated with increased risk for AF recurrence in all studies included. Meta‐analysis of these studies showed that DTAT had a hazard ratio (HR) of 1.19 [1.02, 1.39], P = .03; I2: 92% for AF recurrence. Upon sensitivity analysis by removing a study, HR became 1.24 [1.16, 1.32], P < .001; I2: 29%. Meta‐analysis on DTAT time >3 years had HR 1.73 [1.54, 1.93], P < .001; I2: 45% for the recurrence of AF. Upon subgroup analysis of data that compared >6 years to <1 year, the HR was 1.93 [1.62, 2.29], P < .001; I2: 0%. Conclusion Longer DTAT time is associated with an increased risk of AF recurrence. Hence, determining management at the earliest possible moment to avoid delay is of utmost importance.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Re Sultsmentioning

confidence: 99%

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Longer diagnosis‐to‐ablation time is associated with recurrence of atrial fibrillation after catheter ablation—Systematic review and meta‐analysis

Pranata

Chintya

Raharjo

et al. 2019

Journal of Arrhythmia

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“…3 In recent years, the time between the AF diagnosis and first AF ablation, or the diagnosis-to-ablation time (DAT), has been shown to predict ATA recurrence after ablation, and a relatively short DAT of less than 3 years was associated with a reduced less risk of AF recurrence. [4][5][6][7][8] Furthermore, non-PV triggers are recognized as leading causes of ATA recurrence after PVI. [9][10][11][12][13][14] However, whether or not continuous AF directly increases non-PV triggers remains unclear.…”

Section: Introductionmentioning

confidence: 99%

Impact of diagnosis‐to‐ablation time on non‐pulmonary vein triggers and ablation outcomes in persistent atrial fibrillation

Tomomasa

Nitta

Inaba³

et al. 2021

Cardiovasc electrophysiol

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Introduction: Non-pulmonary vein (PV) triggers are a major cause of atrial tachyarrhythmia (ATA) recurrence after catheter ablation. However, the effect of the diagnosisto-ablation time (DAT) on non-PV triggers in persistent atrial fibrillation is unknown.Methods and Results: This observational study evaluated 502 consecutive persistent AF patients who underwent initial ablation. We compared 408 patients whose DAT was <3 years with 94 patients whose DAT was ≥3 years. Following PV and posterior wall isolation, 193 non-PV triggers, including 50 AFs, 30 atrial tachycardias (ATs), and 113 repetitive atrial premature beats, were elicited and ablated in 137 (27%) patients. Specifically, 80 non-PV AF/AT triggers were provoked in 64 (13%) patients, being identified more frequently in the DAT ≥ 3 years group than in the DAT < 3 years group (20% vs. 11%, p = .025) especially with a higher prevalence of coronary sinus/inferior left atrial triggers. During a median follow-up of 770 days, the ATA recurrence-free rate was higher in the DAT < 3 years group than the DAT ≥ 3 years group (79% vs. 53% at 2 years, p < .001). In a multivariate analysis, female sex (odds ratio: 2.70, p = .002) and a longer DAT (odds ratio: 1.13/year,

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Meta‐analysis of cryoballoon ablation versus antiarrhythmic drugs as initial therapy for symptomatic atrial fibrillation

Mao

Feng

Huang

et al. 2021

Clinical Cardiology

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Background: The optimal first-line approach for patients with symptomatic atrial fibrillation (AF) remains unclear. We compared the efficacy and safety of cryoballoon ablation (CBA) and antiarrhythmic drugs (AADs) in the initial management of symptomatic AF.Hypothesis: CBA is superior to AAD as initial therapy for symptomatic AF.Methods: We searched the EMBASE, PubMed, and Cochrane Library databases for randomized controlled trials (RCTs) that compared CBA with AAD as first-line treatment for AF from the date of database establishment until March 18, 2021. The risk ratio (RR) with a 95% confidence interval (CI) was used as a measure of treatment effect.Results: Three RCTs that enrolled 724 patients in total were included in this metaanalysis. Majority of the patients were relatively young and had paroxysmal AF. CBA was associated with a significant reduction in the recurrence of atrial arrhythmia compared with AAD therapy, with low heterogeneity (RR, 0.59; 95% CI, 0.49-0.71; p < .00001; I 2 = 0%). There was a significant difference in the rate of symptomatic atrial arrhythmia recurrence (RR, 0.44; 95% CI, 0.29-0.65; p < .0001; I 2 = 0%); however, the rate of serious adverse events was similar between the two treatment groups (RR: 1.18; 95% CI: 0.71-1.97, p = .53; I 2 = 0%). Transient phrenic nerve palsy occurred in four patients after the CBA procedure. Conclusion:The current meta-analysis suggests that CBA is more effective than AAD as initial therapy in patients with symptomatic paroxysmal AF. Serious iatrogenic adverse events are uncommon in CBAs.

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Early choice for catheter ablation reduced readmission in management of atrial fibrillation: Impact of diagnosis-to-ablation time

Cited by 33 publications

References 20 publications

Longer diagnosis‐to‐ablation time is associated with recurrence of atrial fibrillation after catheter ablation—Systematic review and meta‐analysis

Longer diagnosis‐to‐ablation time is associated with recurrence of atrial fibrillation after catheter ablation—Systematic review and meta‐analysis

Impact of diagnosis‐to‐ablation time on non‐pulmonary vein triggers and ablation outcomes in persistent atrial fibrillation

Meta‐analysis of cryoballoon ablation versus antiarrhythmic drugs as initial therapy for symptomatic atrial fibrillation

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