Very early versus early referral for ablation in young patients with newly diagnosed paroxysmal atrial fibrillation

Abstract

Background: Catheter ablation (CA) has emerged as an effective therapy for the treatment of paroxysmal atrial fibrillation (AF); however it is unclear whether proceeding expeditiously to CA improves clinical outcomes in a real-world population. This study compares outcomes of CA for new AF within 6 months of diagnosis (very early) 6 to 12 months after diagnosis (early) and 12 to 24 months after diagnosis (later).Methods: A large nationally-representative sample of patients ages 18 to 64 who underwent CA from January 2011 to June 2019 was studied using the IBM Mar-ketScan Database. The primary outcome was a composite of healthcare utilization over the following 24 months. Propensity score-matching was used to match patients in each cohort. Risk difference in outcomes were compared between matched patients.Results: Two thousand six hundred thirty one patients were identified postmatching, with 1649 in the very early cohort and 982 in the early cohort. The very early referral group was less likely to experience the primary composite outcome postablation

Healthcare utilization and costs associated with a diagnosis of incident atrial fibrillation

“… 25 The study suggested significant undertreatment among newly diagnosed patients with AF within the first year of diagnosis. When examining differences in healthcare utilization among patients who underwent early ablation (within 6 months of incident AF diagnosis) versus those who had ablation later (post-6 months), D’Angelo and colleagues 26 found that the former group had a significantly lower medical visits burden as compared to the latter. As seen in this study, AF places a considerable burden within a year of diagnosis among patients; therefore, providers should consider having conversations with patients on early treatment of AF using recommended treatment modalities.…”

Atrial fibrillation: Rate control or rhythm control?

“…On subgroup analysis, the maximal benefit of catheter ablation was in younger patients. 16 D'Angelo et al 17 performed a retrospective study and found results comparable to those of CABANA, with early referral for catheter ablation showing better outcomes as opposed to late referral.…”

Does radiofrequency ablation procedural data improve the accuracy of identifying atrial fibrillation recurrence?

“…Persistent AF is the advanced stage of AF with long lasting episodes of arrhythmia than paroxysmal AF. Early ablation (referred as RFA within 1 year of AF diagnosis) can lead to improvements in adverse cardiac remodeling, greater success in maintain sinus rhythm, and decreased need for repeat ablation based on the results of clinical trials and systematic reviews [12,13]. Based on meta-analysis results of randomized trials, catheter ablation as first-line rhythm control therapy was associated with lower incidence of atrial tachyarrhythmias…”