Association Between Diagnosis-to-Ablation Time and Postablation Outcomes in Older Patients With Persistent Atrial Fibrillation

BACKGROUND: The relationship between the timing of catheter ablation and post-ablation outcomes in older patients with persistent atrial fibrillation (AF) remains uncertain. OBJECTIVES: This study aimed to investigate whether diagnosis-to-ablation time (DAT) influences post-ablation outcomes in older patients with persistent AF. METHODS: From January 2020 to December 2022, 587 patients were stratified into 2 groups: the early ablation group (DAT ≤12 months, n = 332) and the late ablation group (DAT >12 months, n = 255) based on DAT. The study outcomes included freedom from atrial arrhythmia (AA) recurrence and adverse cardiovascular outcomes (death, cardiovascular hospitalization, ischemic stroke, and a composite outcome comprising all 3 outcomes). RESULTS: The final analysis included 560 patients after 27 patients were lost to follow-up. After 24 months follow-up, 67.9% (216/318 patients) with the early ablation group were freedom from AA recurrence vs 59.1% (143/242 patients) in the late ablation group (HR: 0.68; 95% CI: 0.52-0.91; P = 0.005). Moreover, the late ablation group showed higher risks of the composite outcome (HR: 1.70; 95% CI: 1.23-2.34; P = 0.001) and cardiovascular hospitalization (HR: 1.57; 95% CI: 1.10-2.26; P = 0.011) compared with the early ablation group at 24-month follow-up. Ischemic stroke (HR: 1.87; 95% CI: 0.83-4.19; P = 0.126) and death (HR: 2.20; 95% CI: 0.54-8.93; P = 0.267) did not differ significantly between the 2 groups. CONCLUSIONS: In older patients with persistent AF, a DAT ≤12 months was associated with lower AA recurrence and lower risk of adverse cardiovascular outcomes, suggesting that early catheter ablation may improve clinical outcomes in this population.