Impact of catheter ablation timing according to duration of atrial fibrillation history on arrhythmia recurrences and clinical outcomes: a meta-analysis

Catheter ablation is a well-established treatment for symptomatic paroxysmal atrial fibrillation (PAF) or persistent atrial fibrillation (PsAF) refractory to antiarrhythmic agents, and current guidelines have also upgraded its role as a first-line option for recurrent PAF. However, the optimal timing to maximize rhythm outcomes remains uncertain. To address this gap, the present study sought to investigate the association between diagnosis-to-ablation time (DAT) and age-stratified atrial fibrillation (AF) recurrence and clinical outcomes.

Medline, the Cochrane Library, and Scopus were searched through 18 February 2025. Triple-independent selection, extraction, and quality assessment were conducted, with evidence pooled via random-effects meta-analyses. Among the 28 studies (41 431 participants) with a median 24-month follow-up, early ablation (DAT ≤ 1 year) significantly reduced AF recurrence compared to delayed ablation [hazard ratio (HR) 0.65, 95% confidence interval (CI) 0.59–0.73]. The benefit of early ablation was consistent for both PAF (HR 0.72, 95% CI 0.67–0.77) and PsAF (HR 0.70, 95% CI 0.61–0.81). Age-stratified analysis revealed that this effect was significant regardless of age, with the greatest risk reduction observed in individuals ≤ 55 years (HR 0.49, 95% CI 0.34–0.71). Early ablation was also associated with a reduced risk of repeat ablation, new cardioversion, and cardiovascular hospitalization compared to delayed ablation. Higher CHA₂DS₂-VASc scores, heart failure prevalence, and lower mean left ventricular ejection fraction were associated with greater benefits from early ablation.

Early catheter ablation within 1 year of AF diagnosis is associated with a lower risk of recurrence in both PAF and PsAF, with the strongest association observed in patients ≤ 55 years.