Diagnosis-to-ablation time in atrial fibrillation: A modifiable factor relevant to clinical outcome.

Autor: Bisbal F; Heart Institute (iCor), University Hospital Germans Trias i Pujol, Badalona, Spain.; Instituto de Salud Carlos III, CIBERCV, Madrid, Spain., Alarcón F; Atrial Fibrillation Unit (UFA), Hospital Clinic, Universitat de Barcelona, IDIBAPS, Barcelona, Spain., Ferrero-De-Loma-Osorio A; Cardiology Department, Hospital Clínico de Valencia, Valencia, Spain., González-Ferrer JJ; Instituto de Salud Carlos III, CIBERCV, Madrid, Spain.; Cardiology Department, Hospital Clinico San Carlos, Madrid, Spain., Alonso-Martín C; Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain., Pachón M; Cardiology Department, Hospital Virgen de la Salud, Toledo, Spain., Vallés E; Cardiology Department, Hospital del Mar, Barcelona, Spain., Cabanas-Grandío P; Cardiology Department, Hospital Álvaro Cunqueiro, Vigo, Spain., Sanchez M; Cardiology Department, Hospital Puerta de Hierro, Majadahonda, Spain., Benito E; Atrial Fibrillation Unit (UFA), Hospital Clinic, Universitat de Barcelona, IDIBAPS, Barcelona, Spain., Sarrias A; Heart Institute (iCor), University Hospital Germans Trias i Pujol, Badalona, Spain., Ruiz-Granell R; Cardiology Department, Hospital Clínico de Valencia, Valencia, Spain., Pérez-Villacastín J; Instituto de Salud Carlos III, CIBERCV, Madrid, Spain.; Cardiology Department, Hospital Clinico San Carlos, Madrid, Spain., Viñolas X; Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain., Arias MA; Cardiology Department, Hospital Virgen de la Salud, Toledo, Spain., Martí-Almor J; Cardiology Department, Hospital del Mar, Barcelona, Spain., García-Campo E; Cardiology Department, Hospital Álvaro Cunqueiro, Vigo, Spain., Fernández-Lozano I; Cardiology Department, Hospital Puerta de Hierro, Majadahonda, Spain., Villuendas R; Heart Institute (iCor), University Hospital Germans Trias i Pujol, Badalona, Spain., Mont L; Instituto de Salud Carlos III, CIBERCV, Madrid, Spain.; Atrial Fibrillation Unit (UFA), Hospital Clinic, Universitat de Barcelona, IDIBAPS, Barcelona, Spain.
Jazyk: angličtina
Zdroj: Journal of cardiovascular electrophysiology [J Cardiovasc Electrophysiol] 2019 Sep; Vol. 30 (9), pp. 1483-1490. Date of Electronic Publication: 2019 Jun 06.
DOI: 10.1111/jce.14000
Abstrakt: 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.
(© 2019 Canadian Society for Chemical Engineering.)
Databáze: MEDLINE
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