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Early vs delayed ablation for new-onset atrial fibrillation: 5-Year real-world data outcomes
Journal article   Open access   Peer reviewed

Early vs delayed ablation for new-onset atrial fibrillation: 5-Year real-world data outcomes

Jacob R. Heath, Sangwoo Han, Ashraf Alzahrani, David Hamon, E. Michael Powers, Sergio Conti, Peter D. Farjo and Paari Dominic
Heart rhythm O2, Vol.6(12), pp.1886-1892
12/2025
DOI: 10.1016/j.hroo.2025.09.019
PMCID: PMC12800836
PMID: 41541733
url
https://doi.org/10.1016/j.hroo.2025.09.019View
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Abstract

Background Updated guidelines recognize catheter ablation as a first-line therapy for symptomatic atrial fibrillation (AF). The optimal timing of catheter ablation following AF diagnosis remains uncertain. Objective This study assessed the impact of diagnosis-to-ablation time (DAT) <1 year vs DAT ≥1 year on AF recurrence and adverse clinical outcomes. Methods We queried the TriNetX Research Network for patients ≥18 years of age with a diagnosis of AF who underwent ablation between January 1, 2010, and June 30, 2019. Patients were stratified into cohorts based on DAT <1 year vs ≥1 year and matched using 1:1 propensity scores, resulting in 8403 patients in each cohort. The primary outcome was AF recurrence, defined as a composite of cardioversion, antiarrhythmic use, or re-ablation at 3 and 5 years, after a 3-month blanking period. Secondary outcomes included a composite of heart failure exacerbation, ischemic stroke, all-cause hospitalization, and mortality, along with individual components. Results DAT <1 year was associated with significantly lower AF recurrence both at 3 years (adjusted odds ratio 0.68 [95% confidence interval: 0.64–0.72]; P < .001) and 5 years (adjusted odds ratio 0.68 [95% confidence interval: 0.64–0.72]; P < .001). At 3 years, all secondary outcomes were significantly reduced in the DAT <1 year group, except for incident cerebrovascular accident and mortality. At 5 years, all secondary outcomes were significantly reduced in the DAT <1 year group. Conclusion Catheter ablation within 1 year of AF diagnosis is associated with reduced AF recurrence and major adverse clinical outcomes. These findings support early referral for catheter ablation.
 Atrial fibrillation Catheter ablation Electrophysi-ology Arrhythmia Cardiac

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