Redo ablation for AF improves symptom burden, quality of life
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Data from a patient-reported outcomes registry show most people derive a significant quality of life benefit from redo ablation for atrial fibrillation, with a reduction of both AF burden and health care utilization.
“Even though success rates [after catheter ablation] are high, a significant proportion of patients experience recurrent arrhythmia during follow-up,” Ayman A. Hussein, MD, FHRS, a specialist in heart rhythm disorders at the Robert and Suzanne Tomsich department of cardiovascular medicine of the Sydell and Arnold Miller Family Heart, Vascular & Thoracic Institute at Cleveland Clinic, and colleagues wrote. “In such patients, redo catheter ablation has been suggested to be a more effective management strategy compared to medical therapy alone for the purpose of rhythm control. Nonetheless, data related to quality of life outcomes, AF burden and health care utilization after redo ablations are scarce and no large studies have examined patient-reported outcomes in this setting.”
All patients undergoing redo AF ablation between November 2013 and November 2016 at Cleveland Clinic were included in a prospective registry for ablation outcomes and an automated platform for collection of patient-reported outcomes. Using this database, Hussein and colleagues assessed quality of life and clinical outcomes at baseline, 3 and 6 months after ablation, and every 6 months thereafter for 848 patients (28% women; mean age, 64 years; 51% with persistent AF). Data were collected during 3 years of follow-up. The Atrial Fibrillation Symptom Severity (AFSS) scale was used as the main measure for quality of life; additional variables included patient-reported improvement, AF burden, and AF-related health care utilization including ED visits and hospitalizations.
Researchers observed significant improvement in quality of life measures as reported on automated patient-reported outcome surveys. The baseline median AFSS scale was 12 and ranged between 2 and 4 on subsequent assessments (P < .0001), with at least 70% of patients reporting improvement in their AF-related symptoms.
The proportion of patients in AF fell from 36% at the time of the baseline survey to less than 8% across all time points during follow-up (P < .0001). AF burden was reduced, including frequency and duration of episodes (P < .0001), with an associated decrease in health care utilization, including ED visits and hospitalizations, after 6 months from the time of ablation (P < .0001).
The proportion of patients on anticoagulants or antiarrhythmic drugs also decreased on follow-up across all time points (P < .0001 for all variables).
“Comparable improvements in quality of life, AF burden and health care utilization were observed in subgroup analysis for patients with paroxysmal or persistent AF undergoing repeat ablation,” the researchers wrote. “These findings are reassuring and suggest that most patients can expect significant relief of AF-related symptoms and health burden irrespective of the type of recurrent arrhythmia before redo ablations.”
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