JAMA network open · 2026
Diagnosis-to-Ablation Time and Atrial Arrhythmia Recurrence After Ablation.
СтатьяМногоцентровое исследованиеНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Singleton Matthew J, Thorne Christopher, Dai Chang, Hincapie Daniela, Campos-Villarreal Daniel, Bezenek Susan M, Justice Linda, Varley Allyson, Aloum Obadah, Silverstein Joshua, Mareddy Chinmaya, Zei Paul C, Koplan Bruce A, Oza Saumil, Rajendra Anil, Sackett Matthew, Gmiyah Edmond Obeng, Sellers Matthew, Shantha Ghanshyam, Thosani Amit, Lee Jefferson H, Osorio Jose, REAL-AF Investigators
Аннотация
IMPORTANCE: Diagnosis-to-ablation time (DAT) has emerged as a potential predictor of ablation outcomes in atrial fibrillation (AF). Limited evidence is available on the association of prolonged DAT, and existing studies are constrained by small sample sizes and methodological heterogeneity.
OBJECTIVE: To evaluate whether DAT is associated with atrial arrhythmia recurrence following radiofrequency ablation (RFA) for AF.
DESIGN, SETTING, AND PARTICIPANTS: In this cohort study, patients with AF undergoing de novo RFA from January 2018 to June 2023 in a large, multicenter, clinical practice registry were included. Data were analyzed in August 2024.
EXPOSURE: Available DAT and 1-year postablation follow-up.
MAIN OUTCOMES AND MEASURES: Multivariable Cox regression was used to assess the association between DAT and recurrent atrial arrhythmia (post-blanking period).
RESULTS: A total of 3724 patients were included (1492 [40.1%] female; mean [SD] age, 67.0 [10.0] years; mean [SD] BMI, 31.0 [6.8]; and mean [SD] CHA2DS2-VASc score, 2.8 [1.5]). The median (IQR) DAT was 1 (0-4) year, and 2412 (64.8%) underwent RFA for paroxysmal AF. Compared with patients with DAT of less than 1 year, after adjusting for baseline characteristics and comorbidities, patients with DAT of 1 to 4 years had a 48% higher risk of all atrial arrhythmia recurrence (hazard ratio [HR], 1.48; 95% CI, 1.08-2.01; P = .01), and those with DAT greater than 5 years had a 110% increased risk (HR, 2.10; 95% CI, 1.46-3.02; P < .001).
CONCLUSIONS AND RELEVANCE: In this cohort study of patients undergoing de novo RFA, longer DAT was associated with an increased risk of atrial arrhythmia recurrence at 1 year. These results suggest that delayed referral for ablation may be an important prognostic marker in contemporary clinical practice.
OBJECTIVE: To evaluate whether DAT is associated with atrial arrhythmia recurrence following radiofrequency ablation (RFA) for AF.
DESIGN, SETTING, AND PARTICIPANTS: In this cohort study, patients with AF undergoing de novo RFA from January 2018 to June 2023 in a large, multicenter, clinical practice registry were included. Data were analyzed in August 2024.
EXPOSURE: Available DAT and 1-year postablation follow-up.
MAIN OUTCOMES AND MEASURES: Multivariable Cox regression was used to assess the association between DAT and recurrent atrial arrhythmia (post-blanking period).
RESULTS: A total of 3724 patients were included (1492 [40.1%] female; mean [SD] age, 67.0 [10.0] years; mean [SD] BMI, 31.0 [6.8]; and mean [SD] CHA2DS2-VASc score, 2.8 [1.5]). The median (IQR) DAT was 1 (0-4) year, and 2412 (64.8%) underwent RFA for paroxysmal AF. Compared with patients with DAT of less than 1 year, after adjusting for baseline characteristics and comorbidities, patients with DAT of 1 to 4 years had a 48% higher risk of all atrial arrhythmia recurrence (hazard ratio [HR], 1.48; 95% CI, 1.08-2.01; P = .01), and those with DAT greater than 5 years had a 110% increased risk (HR, 2.10; 95% CI, 1.46-3.02; P < .001).
CONCLUSIONS AND RELEVANCE: In this cohort study of patients undergoing de novo RFA, longer DAT was associated with an increased risk of atrial arrhythmia recurrence at 1 year. These results suggest that delayed referral for ablation may be an important prognostic marker in contemporary clinical practice.