Early or delayed ablation for AF?

A prospective, randomised study investigating the timing of ablation in patients with AF found that it is feasible to treat patients with symptomatic atrial fibrillation (AF) with anti-arrhythmic drugs (AADs) for at least 1 year without hampering the outcomes of subsequent ablation.

Prof. Jonathan Kalman (Royal Melbourne Hospital, Australia) and colleagues conducted a prospective, multicentre study to compare the outcomes of early ablation (i.e. <1 month after diagnosis) with optimised AAD plus delayed ablation (i.e. 12 months after diagnosis) in patients with AF [1]. The study included 89 participants, 41 of whom received early ablation and 48 participants underwent delayed ablation. The primary outcome was atrial arrhythmia-free survival at 12 months post-ablation.

At 12 months after ablation, no difference was measured between the early ablation group and the delayed ablation group in atrial arrhythmia-free survival (43.7% vs 41.4%; P=0.82). Similarly, 1 year after ablation the 2 study groups did not differ in terms of atrial arrhythmia burden, symptom severity, or AAD use.

According to Prof. Kalman, the current study provided reassuring evidence that, if applicable, patients with symptomatic AF may be treated with AADs for at least 1 year, without negatively influencing the results of subsequent ablation.

1. 
   
   1. Kalman JM, et al. Impact of catheter ablation timing on atrial arrhythmia outcomes: Early versus delayed ablation. Late-Breaking Science Day 1, EHRA 2023, 16–18 April, Barcelona, Spain.

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Posted on 3 May 20236 September 2023