Diagnosis-to-ablation time as a predictor of success: early choice for pulmonary vein isolation and long-term outcome in atrial fibrillation: results from the Middelheim-PVI Registry

The aim of the study is to define long-term outcome of pulmonary vein isolation (PVI) in atrial fibrillation (AF) and to determine whether time window between AF diagnosis and PVI affects outcome.

Consecutive AF patients undergoing PVI (2006–14) were followed for 5 years. Primary outcome was clinical success, defined as freedom of documented AF without anti-arrhythmic drugs respecting a 1-month blanking period. A 1000 patients were included (age 60 ± 10 years, CHA₂DS₂-VASc score 1 ± 1). The cohort was divided in four quartiles (Q) according to the diagnosis-to-ablation time (DAT): Q1 DAT 0–11 months (N = 244), Q2 DAT 12–≤33 months (N = 254), Q3 DAT 34-≤70 months (N = 252) and Q4 DAT 71–360 months (N = 250). Mean follow-up was 44.3±21.0 months. At 5 years, clinical success was achieved in 45.2 ± 2.0% of patients. Independent predictors of clinical success were AF type (HR = 0.61; 95%CI 0.50–0.74; P < 0.0001), left atrial size (HR = 1.03; 95%CI 1.02–1.05; P < 0.0001), DAT (HR = 1.00; 95%CI 1.00–1.00; P = 0.001), ablation technique (P = 0.012), and year of ablation (HR = 0.93; 95%CI 0.86–1.00; P = 0.045) in multivariable-adjusted analysis. The highest clinical success was achieved when PVI was performed within the first year, and gradually declined with increasing DAT: 55.9 ± 4.6% for Q1, 46.9 ± 4.0% for Q2, 45.5 ± 3.6% for Q3, and 35.5 ± 3.6% for Q4 (P < 0.001).

Long-term success rate of PVI is 45.2 ± 2.0%. Shorter diagnosis-to-ablation times are associated with better clinical success. Our data advocate for early PVI following diagnosis of AF.