JACC Clin Electrophysiol. 2025;11(5):956-965.
Benefits of Early Catheter Ablation in Patients With Atrial Fibrillation: A Nationwide Cohort Study.
제1저자 권순일, 이소령 · 교신저자 최의근
소속 (7)
- Division of Cardiology, Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea.
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea. Electronic address: choiek17@snu.ac.kr.
- Department of Medical Statistics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea.
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Liverpool Centre for Cardiovascular Science at the University of Liverpool, Liverpool John Moores University and Liverpool Chest and Heart Hospital, Liverpool, United Kingdom; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
Abstract
BACKGROUND Although early rhythm control showed better clinical outcomes in patients with atrial fibrillation (AF), limited data exist on the relationship between the timing of atrial fibrillation catheter ablation (AFCA) and clinical outcomes.
OBJECTIVES This study investigated the impact of early vs late AFCA on clinical outcomes.
METHODS Using the Korean claims database, 944,710 AF patients without previous AFCA were investigated. These patients were categorized into 3 groups based on the duration from their AF diagnosis to AFCA: <1 year (early-AFCA), 1 to <3 years (intermediate-AFCA), and ≥3 years (late-AFCA). The study outcomes included ischemic stroke, heart failure (HF) hospitalization, myocardial infarction, major adverse cardiovascular events (comprising the aforementioned three), all-cause mortality, a composite outcome (encompassing all mentioned outcomes), and AF recurrence.
RESULTS A total of 57,804 AF patients (38,536 without AFCA and 19,268 with AFCA; mean age 57.8 years; 73.5% men) were followed up for an average of 2.6 ± 1.5 years. AFCA was associated with lower risks across all study outcomes (HRs: 0.26-0.41 for all outcomes; all P < 0.001). Compared with the early-AFCA group, the intermediate- and late-AFCA groups showed higher risks of HF hospitalization and all-cause mortality. Additionally, the late-AFCA group had higher risks of major adverse cardiovascular events, composite outcomes, and AF recurrence than those of the early- and intermediate-AFCA groups. After weighing the propensity scores, the results were largely consistent with the primary analysis.
CONCLUSIONS Early AFCA showed improved clinical outcomes, primarily caused by decreased risk of HF hospitalization and AF recurrence.
Copyright © 2025 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Keywords
atrial fibrillationcatheter ablationcomparative studyepidemiologytreatment outcome
Conflict of interest statement
Funding Support and Author Disclosures This research was supported by a grant from the Patient-Centered Clinical Research Coordinating Center funded by the Ministry of Health and Welfare, Republic of Korea (grant number: HC21C0028), and by the Korea Medical Device Development Fund grant funded by the Korea government (the Ministry of Science and ICT, the Ministry of Trade, Industry and Energy, the Ministry of Health and Welfare, the Ministry of Food and Drug Safety) (Project Number: HI20C1662, 1711138358, KMDF_PR_20200901_0173). Dr E.-K. Choi has received research grants or speaker fees from Abbott, Bayer, Bristol Myers Squibb/Pfizer, Biosense Webster, Chong Kun Dang, Daewoong Pharmaceutical Co, Daiichi Sankyo, DeepQure, Dreamtech Co, Ltd, Jeil Pharmaceutical Co Ltd, Medtronic, Samjinpharm, Seers Technology, and Skylabs. Dr Lip has served as a consultant and speaker for Bristol Myers Squibb/Pfizer, Boehringer Ingelheim, Anthos, and Daiichi Sankyo (no fees are received personally); is a National Institute for Health and Care Research Senior Investigator; and is co-PI of the AFFIRMO project on multimorbidity in AF (grant agreement no 899871), TARGET project on digital twins for personalized management of atrial fibrillation and stroke (grant agreement no 101136244), and ARISTOTELES project on artificial intelligence for management of chronic long-term conditions (grant agreement no 101080189), which are all funded by the EU’s Horizon Europe Research and Innovation programme. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
그 밖의 정보
- 출판 형태
- Journal Article, Research Support, Non-U.S. Gov't
- 저널
- JACC. Clinical electrophysiology · eISSN 2405-5018
- 전자 출판
- 2025-02-19
- MeSH
- Humans · Atrial Fibrillation* / surgery / epidemiology / mortality · Catheter Ablation* / methods / statistics & numerical data · Male · Female · Middle Aged · Aged · Republic of Korea / epidemiology · Treatment Outcome · Cohort Studies · Recurrence · Hospitalization / statistics & numerical data · Time Factors · Heart Failure / epidemiology