Abstract 15314: Rhythm Outcome of Persistent Atrial Fibrillation Ablation Depending on the Timing of the First Electrocardiographic Documentation

• Published in: Circulation (New York, N.Y.) Vol. 148; no. Suppl_1
• Main Authors: Kim, Hongju, Kim, Kipoong, Kim, Daehoon, Choi, Sung Hwa, Kim, Moon-Hyun, Park, Je W, Yu, Hee Tae, Uhm, Jae-Sun, JOUNG, BOYOUNG, LEE, Moon Hyoung, Pak, Hui-Nam
• Format: Journal Article
• Language: English
• Published: 07.11.2023
• DOI: 10.1161/circ.148.suppl_1.15314
• ISSN: 0009-7322

Abstract only Introduction: Recently, delaying atrial fibrillation (AF) catheter ablation (AFCA) by 12 months for antiarrhythmic drug (AAD) management didn't result in reduced ablation efficacy. In this study, we explored AFCA rhythm outcomes based on the diagnosis-to-ablation time (DAT) in AAD-resistant persistent AF (PeAF). Methods: We included 1,038 AAD-resistant PeAF patients with clear DAT (male 79.8%, 61.0 [54.0-68.0]) who underwent AFCA followed by guidelines-based regular rhythm follow-up. Before AFCA, all patients underwent optimal medial therapy (AAD) with or without cardioversion. Patients on AADs, who experienced paroxysmal type recurrence, were classified as AAD-partial-responders, while those maintaining PeAF were categorized as AAD-non-responders. We determined the DAT cut-off for rhythm outcome using a maximum likelihood approach in a Cox regression model. Results: AAD-partial-responders showed higher body mass index (p=0.007), larger left atrial diameter (p<0.001), lower eGFR (p=0.039). AAD non-responder showed higher recurrence after AFCA (Log-rank p<0.001; aHR 1.75, 95% CI 1.33-2.30, p<0.001). The maximum likelihood estimation from Cox analysis showed bimodal peaks at 22 and 40 months. In contrast, DAT 12 months didn't show discrimination power for post-AFCA recurrence (Log-rank p=0.290, HR1.13[0.91-1.41], p=0.281), while DAT>22 months (Log-rank p=0.001, HR1.34[1.09-1.64], p=0.005) and DAT>40 months (Log-rank p=0.001, HR1.34[1.09-1.64], p=0.006) significantly indicated poor rhythm outcome. DAT>22 months among AAD-partial-responders (Log-rank p=0.012, HR 1.96 [1.16-3.31], p=0.012) and DAT>40 months among AAD-non-responders (Log-rank p=0.009, HR 1.28 [1.02-1.60], p=0.031) were a poor prognostic factor for rhythm control after AFCA. Conclusions: DAT and AAD responsiveness affected the rhythm outcome of AFCA. Delaying AFCA over 22 months of DAT is not desirable in PeAF patients even under optimal medical therapy with AADs.