Diagnosis-to-ablation time in atrial fibrillation: A modifiable factor relevant to clinical outcome
Por:
Bisbal, F, Alarcon, F, Ferrero-De-Loma-Osorio, A, Gonzalez-Ferrer, JJ, Alonso-Martin, C, Pachon, M, Valles, E, Cabanas-Grandio, P, Sanchez, M, Benito, E, Sarrias, A, Ruiz-Granell, R, Perez-Villacastin, J, Vinolas, X, Arias, MA, Marti-Almor, J, Garcia-Campo, E, Fernandez-Lozano, I, Villuendas, R, Mont, L
Publicada:
1 sep 2019
Resumen:
Introduction Recurrences after atrial fibrillation (AF) ablation are still common. Among the reported clinical and imaging predictors of recurrences, diagnosis-to-ablation time (DAT) has been defined as a predictor of ablation outcome in single-center studies. We aimed to validate DAT in a multicenter real-life cohort. Methods This was a multicenter study including consecutive patients undergoing first paroxysmal and persistent AF ablation with radiofrequency or cryoballoon catheters during 2013. Cox proportional hazard regression models were performed to identify predictors of recurrence. Results In total, 309 patients were included across nine centers (71% men, 57 +/- 10 years old, 46% with hypertension, and 66% with CHA(2)DS(2)-VASc <= 1). Most patients had paroxysmal AF (67%) and underwent radiofrequency ablation (68%) with a median DAT of 51 (43) months. Patients with DAT <= 1 year (16.6%) were less likely to have repeat procedures (4% vs 18%; P = .017). The adjusted proportional hazards Cox model identified hypertension (P = .005), heart failure (P = .011), nonparoxysmal AF (P = .038), DAT > 1 year (P = .007), and LA diameter (P = .026) as independent predictors for AF recurrence. DAT > 1 year was the only modifiable factor independently associated with recurrence (HR 4.2 [95% CI, 1.5-11.9]) Conclusion Diagnosis-to-ablation time is a modifiable factor independently associated with recurrent arrhythmia and repeat ablation after first AF ablation. An early intervention strategy during the first year from AF diagnosis might improve outcomes.
Filiaciones:
Bisbal, F:
Univ Hosp Germans Trias & Pujol, Heart Inst iCor, Badalona, Spain
Inst Salud Carlos III, CIBERCV, Madrid, Spain
Alarcon, F:
Univ Barcelona, IDIBAPS, Hosp Clin, Atrial Fibrillat Unit UFA, Barcelona, Spain
Ferrero-De-Loma-Osorio, A:
Hosp Clin Valencia, Cardiol Dept, Valencia, Spain
Gonzalez-Ferrer, JJ:
Inst Salud Carlos III, CIBERCV, Madrid, Spain
Hosp Clin San Carlos, Cardiol Dept, Madrid, Spain
Alonso-Martin, C:
Hosp Santa Creu & Sant Pau, Cardiol Dept, Barcelona, Spain
Pachon, M:
Hosp Virgen Salud, Cardiol Dept, Toledo, Spain
Valles, E:
Hosp del Mar, Cardiol Dept, Barcelona, Spain
Cabanas-Grandio, P:
Hosp Alvaro Cunqueiro, Cardiol Dept, Vigo, Spain
Sanchez, M:
Hosp Puerta Hierro, Cardiol Dept, Majadahonda, Spain
Benito, E:
Univ Barcelona, IDIBAPS, Hosp Clin, Atrial Fibrillat Unit UFA, Barcelona, Spain
Sarrias, A:
Univ Hosp Germans Trias & Pujol, Heart Inst iCor, Badalona, Spain
Ruiz-Granell, R:
Hosp Clin Valencia, Cardiol Dept, Valencia, Spain
Perez-Villacastin, J:
Inst Salud Carlos III, CIBERCV, Madrid, Spain
Hosp Clin San Carlos, Cardiol Dept, Madrid, Spain
Vinolas, X:
Hosp Santa Creu & Sant Pau, Cardiol Dept, Barcelona, Spain
Arias, MA:
Hosp Virgen Salud, Cardiol Dept, Toledo, Spain
Marti-Almor, J:
Hosp del Mar, Cardiol Dept, Barcelona, Spain
Garcia-Campo, E:
Hosp Alvaro Cunqueiro, Cardiol Dept, Vigo, Spain
Fernandez-Lozano, I:
Hosp Puerta Hierro, Cardiol Dept, Majadahonda, Spain
Villuendas, R:
Univ Hosp Germans Trias & Pujol, Heart Inst iCor, Badalona, Spain
Mont, L:
Inst Salud Carlos III, CIBERCV, Madrid, Spain
Univ Barcelona, IDIBAPS, Hosp Clin, Atrial Fibrillat Unit UFA, Barcelona, Spain
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