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INTRODUCTION: Cryoballoon ablation is a safe and efficient rhythm control strategy in atrial fibrillation (AF) patients. The impact of time from diagnosis to ablation is unclear. The aim of this study was to examine the impact of timing of first-time cryoballoon ablation on AF recurrence in a nationwide cohort of AF patients. METHODS AND RESULTS: From nationwide registers, all AF patients ≥18 years of age who underwent first-time AF cryoballoon ablation in Denmark from 2012 to 2018 were included. The AF patients were stratified by ablation timing: Early group (≤1 year after AF diagnosis), intermediate group (1-3 years after AF diagnosis), and late group (≥3 years after AF diagnosis). By adjusted Cox regression models, the effect of timing on AF recurrence was examined. This study included 1064 AF patients with a median age of 63 years. Most patients were male (66%) and had paroxysmal AF (67%). The 1-year risk of AF recurrence increased from 31% in the early group to 41% and 44% in the intermediate and late group. The hazard ratios (95% confidence intervals) were 1.28 (0.95, 1.74) in the intermediate group and 1.42 (1.09, 1.86) in the late group when compared to the early group. Continuous diagnosis-to-ablation time seemed to have the greatest impact on AF recurrence within the first 2 years. CONCLUSION: In AF patients undergoing cryoballoon ablation, late timing of ablation was associated with a significantly higher AF recurrence rate when compared to early timing of ablation. These findings support early cryoballoon ablation to improve the outcomes after ablation.
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BACKGROUND: The treatment of atrial fibrillation (AF) in hypertrophic cardiomyopathy (HCM) can be challenging since AF aggravates symptoms and increases the risk of stroke. Which factors contribute to the development of AF and stroke in HCM remains unknown. PURPOSE: Determine the incidence of AF and stroke in HCM patients and identify risk factors. METHODS: Using Danish National Registers all HCM patients from 2005-2018 were included. The association between HCM, incident AF and stroke was investigated using multivariable Cox proportional-hazard analysis. Cumulative incidences were calculated using the Aalen-Johansen estimator. RESULTS: Among 3,367 patients without prevalent AF, 24% reached the endpoint of incident AF with death as a competing risk. Median follow-up time was 4 years. AF incidence was equal between sexes and increased for patients with ischemic heart disease (HR 1.33, CI[1.08-1.63]), hypertension (HR 1.36, CI[1.14-1.67]) and obstructive HCM (HR 1.27, CI[1.05-1.52]). A total of 7% developed stroke, with no difference detected stratifying for presence of AF. Sub-analysis revealed that when AF was treated with oral anticoagulants (OAC) stroke was less likely (HR 0.4, CI[0.18-0.86], p = 0.02). However, 34% of patients were not receiving adequate anticoagulation following AF diagnosis. CONCLUSION: Obstructive HCM, hypertension and ischemic heart disease was associated with increased risk of AF. Prevalent AF alone was not predictive of stroke, however AF patients treated with OAC were significantly less likely to develop stroke, suggesting that this development is driven by the protective effect of OAC. Despite this, 34% of patients did not receive OAC.