Influence of time to ablation on outcomes among patients with atrial fibrillation with pre-existing heart failure

Background Atrial fibrillation (AF) and heart failure (HF) are cardiac disorders that often coexist. Objective This study aimed to investigate how time to ablation could influence the outcomes of AF patients with pre-existing HF. Methods Using the 2013 to 2022 Optum Clinformatics database, AF patients with pre-existing HF were classified into 2 groups: early ablation (ablation within 6 months of AF diagnosis) and late ablation (ablation in the 6- to 24-month period after AF diagnosis). Outcomes including AF-related hospitalization, electrical cardioversion, repeat ablation, antiarrhythmic drug (AAD) use, and AF recurrence (a composite outcome of the aforementioned events) were assessed in the postblanking 24-month period. Inverse probability of treatment weighted Poisson regression estimated risk ratio (RR) and 95% confidence interval (CI) for each outcome. Results Overall, 601 patients were identified (early ablation: 347; late ablation: 254). In 24 months, the weighted data suggested that patients in the early ablation cohort had significantly lower rate of composite outcome (49.32% vs 61.39%, P = .01), repeat ablation (8.56% vs 17.35%, P < .01), and AAD use (35.95% vs 47.92%, P = .01). Early ablation was associated with a 20%, 51%, and 25% lower risk of composite outcome (RR 0.80, 95% CI 0.69-0.94), repeat ablation (RR 0.49, 95% CI 0.31-0.79), and AAD use (RR 0.75, 95% CI 0.61-0.92), respectively. No significant difference in AF-related hospitalization and electrical cardioversion were observed. Conclusion AF patients with pre-existing HF undergoing ablation within 6 months of AF diagnosis have a lower risk of AF recurrence than those undergoing late ablation, which was evidenced by a lower rate of repeat ablation and AAD use.