211 Effect of Outcome Measures on the Apparent Efficacy of Ablation for Atrial Fibrillation

Abstract

Different patient populations and different criteria for efficacy can dramatically affect the perceived benefits of Atrial Fibrillation Ablation (AF). We defined three endpoints for recurrence of AF post ablation in a cohort of 200 patients with symptomatic AF, refractory to antiarrhythmic drug (AADs). Group 1 was considered to have a recurrence with any symptomatic or documented recurrence with no blanking period, and off their AADs, group 2 with only documented recurrence after blanking period, either on or off their AADs, and group 3 were similar to group 2, with allowing 1 redo ablation or 1 DC Cardioversion. We also surveyed 50 patients on the waiting list for an AF ablation and asked them key questions regarding what they would consider to be a successful result for them (see table).Tabled 1QUESTIONYes, (%)No, (%)High burden versus low burden AF. (High: ≥weekly, Low <weekly)26 (52)24 (48)Would you consider having just one or two recurrences a good outcome?38 (76)12 (24)Would you be accepting one repeat procedure or one DCCV?35 (70)15 (30)Would you consider having half the amount of AF you previously had as a Successful procedure/good outcome?35 (70)15 (30)Would you expect to be completely off AADs?34 (68)16 (32) Open table in a new tab Freedom from recurrence of atrial tachyarrhythmias at one year was 62% for group1, 87% for group 2, and 90% for group 3, and at five years was 62%, 73%, and 80% for Groups 1, 2, and 3, respectively. There were statistically significant differences between the Hazard Ratio for the pairwise comparison between the different criteria groups (p<0.01). In this study the most important predictor of AF recurrence following ablation was the criteria used to define recurrence (follow-up duration, using blanking period, and AADs). The majority of patients still considered AF ablation a successful treatment if they had up to two recurrences of AF, one repeat procedure or one DCCV.