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.

Summary

This meta-analysis of 23 studies (n=43,711) found that shorter diagnosis-to-ablation time is associated with significantly lower AF recurrence and reduced all-cause mortality, with a trend toward lower stroke. Benefit is most pronounced when ablation is performed early, and the effect attenuates with delays.

Key Findings

• Shorter diagnosis-to-ablation time was significantly associated with reduced AF recurrence across paroxysmal and persistent AF.
• Earlier ablation was linked to lower all-cause mortality and a trend toward reduced stroke.
• The benefit of early ablation decreased as the delay to ablation increased.

Clinical Implications

Clinicians should consider earlier ablation after AF diagnosis to improve rhythm control durability and survival, integrating timing into shared decision-making and referral pathways.

Limitations

• Heterogeneity across studies and non-randomized designs limit causal inference
• Potential publication bias and residual confounding

Future Directions

Prospective, randomized trials testing early ablation strategies and standardized referral timelines; health-economic analyses of timing-based pathways.