(C-135) Contemporary Trends in Catheter Ablation as First-Line Therapy Among Patients Diagnosed with Paroxysmal Atrial Fibrillation in Routine Clinical Practice in the United States

Background: Catheter ablation is an established effective treatment for symptomatic paroxysmal atrial fibrillation (AF) refractory or intolerant to antiarrhythmic drugs (AAD). Catheter ablation as first-line therapy for symptomatic paroxysmal atrial fibrillation is also considered an appropriate indication in the current expert consensus statement and clinical guidelines on AF catheter ablation based on superior clinical benefits vs AAD demonstrated in multiple randomized clinical trials and meta-analyses. Early AF ablation has also been shown to delay AF progression. However, data are sparse on recent trends in real-world use of catheter ablation as first-line therapy in patients diagnosed with paroxysmal atrial fibrillation.

Objectives: To explore contemporary trends in catheter ablation as first-line therapy in patients diagnosed with paroxysmal atrial fibrillation in routine clinical practice in the US

Methods: A retrospective analysis was conducted in 36,813 patients aged ≥18 years who underwent their first catheter ablation for AF by pulmonary vein isolation and had a diagnosis of paroxysmal atrial fibrillation associated with the same procedure encounter during 2017-2024 in the Optum Clinformatics Extended DataMart, a claims database of commercially insured and Medicare Advantage enrollees from a large US health plan. The percentage of catheter ablation as first-line therapy was calculated by the calendar year of the catheter ablation procedure. Logistic regression and joinpoint models were used to evaluate trends in catheter ablation as first-line therapy over time.

Results: Real-world use of catheter ablation as first-line therapy in patients diagnosed with paroxysmal atrial fibrillation was significantly increased from 31.9% in 2017 to 48.2% in 2024 (p value for trend < 0.0001). The percentage was consistently lower in patients with more comorbid conditions than those with fewer comorbid conditions (44.7% vs 51.7% in 2024 in patients with an Elixhauser comorbidity core of >6 vs ≤6 [median value], respectively). The increasing trend was generally similar by age, gender, race, ethnicity, and setting of care, with a slightly higher percentage among patients aged < 50 years and in the outpatient setting of care in more recent years.

Conclusions: There was an increasing trend in real-world use of catheter ablation as first-line therapy in patients diagnosed with paroxysmal atrial fibrillation in the US, with a nearly 50% of use in 2024. This finding may reflect increasing comfort level with catheter ablation as first-line treatment in routine clinical practice due to multiple demonstrated clinical benefits vs AAD as first-line therapy for symptomatic paroxysmal atrial fibrillation.