First-line vs Second-Line Catheter Ablation Therapy for Patients with Atrial Fibrillation—Data from a National Multicentre Registry

Background: An early catheter ablation treatment strategy is effective for rhythm control in patients with atrial fibrillation (AF). In clinical practice, most patients undergo catheter ablation as a second-line treatment, following a trial of antiarrhythmic drugs (AADs). We aimed to investigate the effectiveness and safety of AF catheter ablation performed as a first-line vs a second-line approach, based on data from the nationwide, multicentre Israeli Catheter Ablation Registry. Methods: Following AF catheter ablation, patients were stratified into 2 groups—first-line vs second-line therapy approaches. The second-line group included AF patients who were referred for catheter ablation following treatment with at least one AAD. The primary endpoint was the 1-year freedom from AF recurrence. The secondary endpoints included 1-year hospitalizations, death, cerebrovascular events, and the composite of adverse cardiac events. Results: The 923 participants had a mean age of 66 ± 4.5 years. Catheter ablation was performed as a first-line therapy in 192 patients (20.8%). Median times from AF diagnosis to catheter ablation were 1.5 and 3 years in the first- and second-line groups, respectively. Patients in the first-line group were younger, had a shorter AF duration, and more frequently had a normal left atrial size prior to the procedure. The primary endpoint of AF recurrence at 1 year did not differ significantly between the groups (24.9% vs 30%, P = 0.205). No significant differences in the incidence of secondary outcomes occurred. Conclusions: Mildly delayed AF catheter ablation for patients with AF did not compromise the procedure's efficacy or safety.