This study assesses practice patterns for treatment of atrial fibrillation within a young nationally-representative and commercially-insured population.Ī retrospective observational study was conducted using medical and prescription claims data from the IBM MarketScan® Commercial Database. It is not well known how this information has translated to real-world practice, particularly with regard to how the frequency of early CA is changing over time, regional differences in practice, and patient specific factors that lead to referral for early CA. Additionally, many US payer-based guidelines mandate treatment with an antiarrhythmic drug prior to referral for catheter ablation, which may delay time to CA and reduce its long-term effectiveness.
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Yet, recent consensus guidelines continue to recommend trial of Class I or Class III anti-arrhythmic prior to CA for AF. In particular, patients who underwent CA within 1 year of AF diagnosis (referred to as “early CA” for study purposes), had the greatest chance of long-term maintenance of sinus rhythm. These studies have not addressed the optimal timing of CA, although a prospective study showed that shorter duration between AF diagnosis and CA reduced rate of AF recurrence and adverse cardiac remodeling, using NT-proBNP and left atrial size as surrogate measures. Additionally, there are several ongoing clinical trials to assess the safety and efficacy of early ablation for AF in patients who have not been treated with AADs (NCT03118518, NCT02686749). A recent retrospective study of younger, commercially-insured patients found that CA resulted in fewer hospitalizations for AF and heart failure. Several randomized controlled trials have sought to assess the effectiveness of CA as a first-line therapy for AF and found CA resulted in decreased AF burden and improved subjective quality of life compared to AADs. Catheter ablation (CA) has emerged as a viable alternative to AADs that may better maintain sinus rhythm or reduce AF burden.Įmerging evidence has suggested that CA may be more effective than AADs for improving symptoms of AF, although the effect of CA on hard patient outcomes including hospitalization, adverse events, and mortality is unclear. Rhythm control strategies have traditionally focused on anti-arrhythmic drugs (AADs), although studies have shown that these drugs have numerous side effects and many patients do not durably maintain sinus rhythm. Patients who are highly symptomatic from AF are candidates for a rhythm control strategy.
Patients are less likely to be referred for early CA if they are located in the Northeast and North Central regions, have more comorbidities, or higher CHA 2DS 2-VASc scores.Ītrial fibrillation (AF) can present with severe symptoms, thromboembolic events, and hemodynamic instability that leads to morbidity and mortality and frequent hospitalizations. ConclusionsĬA within 12 months for new-diagnosed AF increased significantly from 2010 to 2016, with most patients still trialed on an AAD prior to CA. Patients were less likely to undergo CA if they were located in the Northeast (OR: 0.80, CI: 0.73–0.88) or North Central (OR: 0.91, CI: 0.83–0.99) regions (compared with the West), had higher CHA 2DS 2-VASc scores, or had Charlson Comorbidity Index (CCI) score of 3 or greater (OR: 0.61 CI: 0.51–0.72).
ResultsĮarly CA increased from 5.0% in 2010 to 10.5% in 2016. Patients were excluded if they had prior history of AF or had filled an anti-arrhythmic drug (AAD) in the pre-index period. Patients were included with a new diagnosis of AF in the inpatient or outpatient setting with continuous enrollment for at least 1 year pre and post index visit. MethodsĪ large nationally-representative sample of patients age 20 to 64 from years 2010 to 2016 was studied using the IBM MarketScan® Commercial Database. This study examined overall procedural trends and factors predictive of catheter ablation for newly-diagnosed atrial fibrillation in a young, commercially-insured population.
However practice patterns and patient factors associated with referral for CA within the first 12 months after diagnosis are poorly characterized. Catheter ablation (CA) has emerged as an effective treatment for symptomatic atrial fibrillation (AF).
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