Is the time between first diagnosis of paroxysmal atrial fibrillation and cryoballoon ablation a predictor of efficacy?

Abstract

In the total cohort, cryoablation was performed after a median of 36 months from the point of the patient diagnosis with drug refractory symptomatic recurrent atrial fibrillation. The early-treatment group was composed of 130 (25%) patients, whereas the late-treatment group had 380 (75%) patients. Both cohorts had similar baseline clinical characteristics. Of 510 patients, 22 had a complication related to the procedure with no difference between the two groups. Multivariable analysis showed that the risk of atrial fibrillation recurrence was significantly higher in the late-treatment group (hazard ratio: 1.77; 95% confidence interval 1.00-3.13) CONCLUSION: In our multicenter observational examination, cryoablation was well tolerated and effective in the treatment of patients with drug refractory symptomatic paroxysmal atrial fibrillation. Reducing the time between diagnosis and ablation brought about a treatment that had a lower risk of atrial fibrillation recurrence with no change in safety.(Italian ClinicalService Project: NCT01007474).

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

“…This systematic review and meta‐analysis concluded that a longer DTAT is associated with AF recurrence after ablation as early as 12 and 36 months have been demonstrated to have a profound effect on the AF recurrence. Interestingly, shorter DTAT is shown to have a higher AF freedom in both paroxysmal and persistent AF, as shown by studies by Hussein et al who included 100% persistent AF samples and Lunati et al which included a 100% paroxysmal AF samples . 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 .…”

“…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.…”

“…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. The rate of complications on longer vs shorter DTAT were not sufficiently reported, there was a study that showed no significant difference on the rate of complication in both groups …”

“…This systematic review and meta-analysis concluded that a longer DTAT is associated with AF recurrence after ablation as early as shorter DTAT were not sufficiently reported, there was a study that showed no significant difference on the rate of complication in both groups. 12 Atrial fibrillation causes electrical and structural remodeling in the atrium, which further provides substrate, promote occurrence, and maintenance of AF and worsen the condition in a vicious cycle manner. 15 AF has a progressive nature and the complexity increases over time; hence, a longer DTAT means a lengthier period in which the atrium is in the aforementioned vicious cycle.…”

“…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.…”