(A15) Temporal Trends in Using Catheter Ablation as First-Line Therapy in Patients Diagnosed with Paroxysmal Atrial Fibrillation in the United States

Publication Number: 298

Background: More than a decade ago, randomized clinical trials have demonstrated clinical benefits of catheter ablation compared to antiarrhythmic drugs (AADs) in patients with symptomatic paroxysmal atrial fibrillation (AF) refractory or intolerant to AAD. More recently, superiority of catheter ablation as first-line treatment vs AAD has been demonstrated as well. In addition, early AF ablation has been shown to delay AF progression. However, data are limited on contemporary trends of real-world catheter ablation practice as first-line therapy in patients diagnosed with paroxysmal AF.

Objectives: To explore the temporal trends in catheter ablation as first-line therapy in patients diagnosed with paroxysmal AF in the US.

Methods: A retrospective analysis was conducted in adult patients who had a diagnosis of paroxysmal AF and underwent a catheter ablation of AF by pulmonary vein isolation during 2016-2020 from the IBM MarketScan® Commercial Database. The proportion of catheter ablation as first-line therapy in patients diagnosed with paroxysmal AF was calculated according to the calendar year of the catheter ablation procedure. Logistic regression models evaluated the association between the calendar year of the catheter ablation procedure and first-line therapy choice.

Results: There was a significant 61% increase in the proportion of catheter ablation as first-line therapy in patients diagnosed with paroxysmal AF from 2016 (25%) to 2020 (35%) (2020 vs 2016: Odds Ratio, 1.61; 95% confidence interval, 1.42-1.83) (p for trend < 0.0001). The increasing trend was similar by sex, age, and setting of care, but the proportion was slightly higher in younger patients than in older patients and was more pronounced in the inpatient vs outpatient setting of care.

Conclusions: There was an increasing trend in using catheter ablation as first-line therapy in patients diagnosed with paroxysmal AF in the US. This finding may reflect increasing comfort level with catheter ablation due to multiple demonstrated clinical benefits compared to AADs as first-line treatment for symptomatic paroxysmal AF.