UBC’s Jason Andrade, MD on the association between long AF ablation wait times and increased adverse events.

Surgeries & Interventions

Long AF Ablation Delays Drive Adverse Events

A new study out of Canada exposed the country’s long atrial fibrillation ablation wait times, while showing how widespread AF ablation delays can have significant public health consequences. 

The growing support for AF ablation has led to patient demand outpacing procedure capacity, but the length and public health impact of these delays hadn’t been studied. 

To address that evidence gap, the researchers analyzed wait times and outcomes from 6,253 Ontario, Canada-based patients who were referred for de novo AF ablation between April 2016 and March 2020, following them through March 2023.

• Patients who underwent AF ablation waited a median of 218 days
• Patients who never underwent ablation waited a median of 520 days

These wait times might actually be worse than they look, considering that the patients already waited an average of 1.5 years between diagnosis and referral, and noting that ablation delays grew longer throughout the study period.

Longer wait times also came with significant consequences, as 19.2% of patients reached the composite endpoint of death, hospitalization, or an AF/HF ED visit while still on the waitlist (technically, 0.6% died). There was also a direct correlation between length of time on the waitlist and number of adverse events.

Patients with paroxysmal AF faced the greatest MACE risks while on the waitlist, experiencing adverse events 50% more frequently than those with persistent AF, which the authors believe might be due to their symptoms driving a larger share of ED/hospital visits.

The Takeaway

At first glance this might come off as a study about Canada’s long AF ablation wait times, which is less of a problem in the U.S. (we have our own problems). However, there are plenty of other countries that also have long delays for AF ablations, and the study’s evidence supporting the benefits of early ablation seems to be globally relevant.

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