Impact of redo ablation for atrial fibrillation on patient-reported outcomes and quality of life

Medhat Farwati; Mustapha Amin; Walid I Saliba; Hiroshi Nakagawa; Khaldoun G Tarakji; Mohamed Diab; Anna Scandinaro; Ruth Madden; Patricia Bouscher; Shunsuke Kuroda; Mohamed Kanj; Thomas J Dresing; Thomas D Callahan; Mandeep Bhargava; Jakub Sroubek; Bryan Baranowski; John Rickard; Daniel J Cantillon; Patrick J Tchou; Oussama M Wazni; Ayman A Hussein

doi:10.1111/jce.15710

Impact of redo ablation for atrial fibrillation on patient-reported outcomes and quality of life

J Cardiovasc Electrophysiol. 2023 Jan;34(1):54-61. doi: 10.1111/jce.15710. Epub 2022 Nov 2.

Authors

Medhat Farwati¹, Mustapha Amin¹, Walid I Saliba², Hiroshi Nakagawa², Khaldoun G Tarakji², Mohamed Diab², Anna Scandinaro¹, Ruth Madden², Patricia Bouscher², Shunsuke Kuroda², Mohamed Kanj², Thomas J Dresing², Thomas D Callahan², Mandeep Bhargava², Jakub Sroubek², Bryan Baranowski², John Rickard², Daniel J Cantillon², Patrick J Tchou², Oussama M Wazni², Ayman A Hussein²

Affiliations

¹ Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA.
² Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA.

PMID: 36259719
DOI: 10.1111/jce.15710

Abstract

Introduction: Catheter ablation for atrial fibrillation (AF) is frequently used for the purpose of rhythm control and improved quality of life (QoL). Although success rates are high, a significant proportion of patients require redo ablation. Data are scarce on patient-centered outcomes and QoL in patients undergoing redo AF ablation. We aimed to assess QoL and clinical outcomes using a large prospectively maintained patient-reported outcomes (PRO) registry.

Methods: All patients undergoing redo AF ablation (2013-2016) at our center were enrolled in a prospective registry for outcomes and assessed for QoL using automated PRO surveys (baseline, 3 and 6 months after ablation, every 6 months thereafter). Data were collected over 3 years of follow-up. The atrial fibrillation symptom severity scale (AFSSS) was used as the main measure for QoL. Additional variables included patient-reported improvement, AF burden, and AF-related healthcare utilization including emergency room (ER) visits and hospitalizations.

Results: A total of 848 patients were included (28% females, mean age 63.8, 51% persistent AF). By automated PRO, significant improvement in QoL was noted (baseline median AFSSS of 12 [5-18] and ranged between 2 and 4 on subsequent assessments; p < .0001), with ≥70%of patients reported remarkable improvement in their AF-related symptoms. The proportion of patients in AF at the time of baseline survey was 36%, and this decreased to <8% across all time points during follow-up (p < .0001). AF burden was significantly reduced (including frequency and duration of episodes; p < .0001), with an associated decrease in healthcare utilization after 6 months from the time of ablation (including ER visits and hospitalizations; p < .0001). The proportion of patients on anticoagulants or antiarrhythmics decreased on follow-up across all time points (p < .0001 for all variables).

Conclusion: Most patients derive significant QoL benefit from redo AF ablation; with reduction of both AF burden and healthcare utilization.

Keywords: atrial fibrillation; catheter ablation; quality of life.

MeSH terms

Anti-Arrhythmia Agents / therapeutic use
Atrial Fibrillation* / diagnosis
Atrial Fibrillation* / surgery
Catheter Ablation* / adverse effects
Female
Humans
Male
Middle Aged
Patient Reported Outcome Measures
Quality of Life
Treatment Outcome

Substances

Anti-Arrhythmia Agents