Catheter ablation for persistent atrial fibrillation: patterns of recurrence and impact on quality of life and health care utilisation

Rose Crowley; David Chieng; Hariharan Sugumar; Liang-Han Ling; Louise Segan; Jeremy William; Sandeep Prabhu; Aleksandr Voskoboinik; Geoffrey Wong; Joseph B Morton; Geoffrey Lee; Alex J McLellan; Michael Wong; Rajeev K Pathak; Laurence Sterns; Matthew Ginks; Prashanthan Sanders; Jonathan M Kalman; Peter M Kistler

doi:10.1093/eurheartj/ehae291

Catheter ablation for persistent atrial fibrillation: patterns of recurrence and impact on quality of life and health care utilisation

Eur Heart J. 2024 May 17:ehae291. doi: 10.1093/eurheartj/ehae291. Online ahead of print.

Authors

Rose Crowley^{1

2

3}, David Chieng^{1

2

3}, Hariharan Sugumar^{1

2

3

4}, Liang-Han Ling^{1

2

3}, Louise Segan^{1

2

3}, Jeremy William^{1

2

5}, Sandeep Prabhu^{1

2

3}, Aleksandr Voskoboinik^{1

2

5

3

4}, Geoffrey Wong^{3

6}, Joseph B Morton^{3

6}, Geoffrey Lee^{3

6}, Alex J McLellan^{3

6}, Michael Wong^{3

6}, Rajeev K Pathak⁷, Laurence Sterns⁸, Matthew Ginks⁹, Prashanthan Sanders¹⁰, Jonathan M Kalman^{3

6}, Peter M Kistler^{1

2

5

3

4}

Affiliations

¹ The Alfred Hospital, Melbourne, Australia.
² The Baker Heart and Diabetes Research Institute, Melbourne, Australia.
³ University of Melbourne, Melbourne, Australia.
⁴ Cabrini Hospital, Melbourne, Australia.
⁵ Monash University, Melbourne, Australia.
⁶ Royal Melbourne Hospital, Melbourne, Australia.
⁷ Canberra Hospital, ACT, Australia.
⁸ Royal Jubilee Hospital, Vancouver Island, British Columbia, Canada.
⁹ John Radcliffe Hospital, Oxford, UK.
¹⁰ Royal Adelaide Hospital, Adelaide, Australia.

PMID: 38759110
DOI: 10.1093/eurheartj/ehae291

Abstract

Background and aims: Patterns of atrial fibrillation (AF) recurrence post catheter ablation for persistent AF are not well described. This study aimed to describe the pattern of AF recurrence seen following catheter ablation for persistent AF (PsAF) and the implications for healthcare utilisation and quality of life.

Methods: This was a post-hoc analysis of the CAPLA study, an international, multi-centre study that randomised patients with symptomatic PsAF to pulmonary vein isolation plus posterior wall isolation or pulmonary vein isolation alone. Patients underwent twice daily single lead ECG, implantable device monitoring or three monthly Holter monitoring.

Results: 154 of 333 (46.2%) patients (median age 67.3 years, 28% female) experienced AF recurrence at 12-month follow-up. Recurrence was paroxysmal in 97 (63%) patients and persistent in 57 (37%). Recurrence type did not differ between randomisation groups (p=0.508). Median AF burden was 27.4% in PsAF recurrence and 0.9% in paroxysmal AF (PAF) recurrence (p<0.001). Patients with PsAF recurrence had lower baseline left ventricular ejection fraction (PsAF 50% vs PAF 60%, p<0.001) and larger left atrial volume (PsAF 54.2±19.3 ml/m² vs PAF 44.8±11.6 ml/m², p=0.008). Healthcare utilisation was significantly higher in PsAF (45 patients [78.9%]) vs PAF recurrence (45 patients [46.4%], p<0.001) and lowest in those without recurrence (17 patients [9.5%], p<0.001). Patients without AF recurrence had greater improvements in quality of life as assessed by the Atrial Fibrillation Effect on Quality-of-Life (AFEQT) questionnaire (Δ33.3±25.2 points) compared to those with PAF (Δ24.0±25.0 points, p=0.012) or PsAF (Δ13.4±22.9 points, p<0.001) recurrence.

Conclusions: AF recurrence is more often paroxysmal after catheter ablation for PsAF irrespective of ablation strategy. Recurrent PsAF was associated with higher AF burden, increased healthcare utilisation and antiarrhythmic drug use. The type of AF recurrence and AF burden may be considered important endpoints in clinical trials investigating ablation of PsAF.

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

© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.