June 18, 2025
Atrial fibrillation (AFib) is the most common continuous cardiac arrhythmia in adults. It's expected to affect more than 12 million people in the U.S. by 2030.
Catheter ablation and antiarrhythmic drugs are the most common treatments for heart rhythm control. Ablation is associated with a reduction of recurrences compared with medical therapy. However, even with the benefits of ablation, recurrence may occur in 20% to 40% of patients, stressing the need to identify additional predictors for AFib recurrence.
Current clinical guidelines emphasize the importance of rhythm control with catheter ablation but lack guidance on the timing of AFib ablation relative to diagnosis time.
Mayo Clinic cardiovascular researchers sought to investigate the impact of diagnosis to ablation time (DAT) on clinical outcomes after AFib ablation. The findings of the systematic review and meta-analysis were published in Circulation: Arrhythmia and Electrophysiology.
Does timing matter?
While early rhythm control has been emphasized in recent guidelines, the optimal timing of ablation after an AFib diagnosis remains unclear. There's considerable variation in clinical practice, and many patients experience delayed referrals. "We undertook this study to synthesize available evidence on whether the interval between diagnosis to ablation time affects outcomes," says Abhishek J. Deshmukh, M.B.B.S., a cardiologist and cardiac electrophysiologist at Mayo Clinic in Rochester, Minnesota, and one of the study's authors.
Why this research is needed:
- The success rates of catheter ablation for symptomatic AFib vary widely.
- Recurrence is a common problem for many patients.
- Clinical guidelines recommend rhythm control, but they do not give specific guidance on the timing of intervention.
"Recent data has suggested that early control of atrial fibrillation is associated with improved patient outcomes. While it is clear earlier is better, data informing physicians on timing is sparse. This study provides insight into benefits associated with time from diagnosis to timing of catheter ablation. Regardless of the type of atrial fibrillation, a patient had better outcomes in terms of less recurrent AFib if time from diagnosis to ablation was less than a year," says Christopher V. DeSimone, M.D., Ph.D., a cardiac electrophysiologist at Mayo Clinic in Rochester, Minnesota, and senior author of the study.
Remodeling and resistance
Recurrence is affected by atrial remodeling and resistance to successful ablation. "With atrial fibrillation, there appears to be a progression from paroxysmal — a trigger-based disease with a strong dependence on electrical firing from the pulmonary veins — toward persistent AFib, which can involve trigger and substrate. AFib begets more AFib, causing changes to the left atrium, which is part of the progression to persistent AFib. The atria can remodel as a response to atrial fibrillation. This makes patients more prone to AFib, and harder to get patients out of this rhythm and keep them in normal sinus rhythm," says Dr. DeSimone. "The greater the remodeling, the more likely the structure and function of the atrium changes. At some point this progression becomes irreversible, so it's important to maintain sinus rhythm early prior to progression when the disease still remains heavily trigger based."
Unexpected gain
The study delivered some unexpected value. "We were struck by how consistent the benefit of early ablation was, even in patients with persistent AFib," says Dr. Deshmukh. "Although the benefit was slightly attenuated, it remained significant, suggesting that early intervention may still alter the disease course, even once remodeling has begun. The data strongly support early referral for ablation — ideally within a year of diagnosis."
Study highlights:
- The cohort included 23 studies with 43,711 patients.
- Patients who underwent ablation within one year of diagnosis had significantly lower recurrence rates: a 59% reduction in paroxysmal AFib and 25% in persistent AFib.
- The patients treated after one year had a 70% higher recurrence rate in paroxysmal AFib and 30% in persistent AFib.
- Shorter DAT was associated with reduced all-cause mortality and a possible reduction in stroke incidence.
- There was not a significant difference in heart failure between DAT ≤1 year and DAT >1 year.
Next steps
The findings can impact clinical care. "There are things with AFib that we cannot control or modify. This study clearly shows we have the tools to intervene once we have an AFib diagnosis: Earlier catheter ablation to maintain sinus rhythm brings better outcomes," says Dr. DeSimone. "Patients may seek AFib ablation sooner rather than a drug-based approach to rhythm control. Wearables and other diagnostic interventions will play a role in earlier identification and referral to cardiac electrophysiologists sooner, to improve patient outcomes."
Further prospective studies are needed to confirm causality and explore whether DAT can be integrated into risk models. "There's also an opportunity to combine DAT with imaging or biomarker-based assessments to guide individualized timing," says Dr. Deshmukh. "Recognizing DAT as a modifiable factor could help refine care pathways and improve long-term outcomes."
For more information
Amin AM, et al. Impact of diagnosis to ablation time on recurrence of atrial fibrillation and clinical outcomes after catheter ablation: A systematic review and meta-analysis with reconstructed time-to-event data. Circulation: Arrhythmia and Electrophysiology. 2025;18:170.
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