Increasing time between first diagnosis of atrial fibrillation and catheter ablation adversely affects long‐term outcomes in patients with and without structural heart disease

Introduction Atrial Fibrillation (AF) is a common arrhythmia often comorbid with systolic or diastolic heart failure (HF). Catheter ablation is a more effective treatment for AF with concurrent left ventricular dysfunction, however, the optimal timing of use in these patients is unknown. Methods All patients that received a catheter ablation for AF(n = 9979) with 1 year of follow‐up within the Intermountain Healthcare system were included. Patients with were identified by the presence of structural disease by ejection fraction (EF): EF ≤ 35% (n = 1024) and EF > 35% (n = 8955). Recursive partitioning categories were used to separate patients into clinically meaningful strata based upon time from initial AF diagnosis until ablation: 30–180(n = 2689), 2:181–545(n = 1747), 3:546–1825(n = 2941), and 4:>1825(n = 2602) days. Results The mean days from AF diagnosis to first ablation was 3.5 ± 3.8 years (EF > 35%: 3.5 ± 3.8 years, EF ≤ 35%: 3.4 ± 3.8 years, p = .66). In the EF > 35% group, delays in treatment (181–545 vs. 30–180, 546–1825 vs. 30–180, >1825 vs. 30–180 days) increased the risk of death with a hazard ratio (HR) of 2.02(p