Benefit of atrial fibrillation ablation on symptoms and quality of life does not differ between patients with paroxysmal and persistent atrial fibrillation

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background Indications for atrial fibrillation (AF) ablation in current ESC and ACC/HRS guidelines are different for paroxysmal and persistent AF patients. Although previous research has established that the AF recurrence rate after AF ablation is lower in paroxysmal AF patients, there is little data on differences in post-ablation improvement of quality of life (QoL) and AF-related symptoms. Purpose This study aimed to determine whether QoL and symptom improvement differ between patients with paroxysmal and persistent AF after AF ablation. Methods From December 2017 to June 2020, patients undergoing first AF ablation at a medical center were included in a prospective registry. Circumferential pulmonary vein isolation (PVI) was performed using radiofrequency ablation with a contact force-sensing catheter. Patient reported outcomes were assessed at baseline, 4 months follow-up, and 1 year follow-up using the Toronto Atrial Fibrillation Severity Scale (AFSS). The AFSS was used to quantify global well-being (scale 1-10), patient-perceived AF burden (scale 3-30), and AF symptom severity (scale 0-35). AF symptom severity was based on 7 questions (scale 0-5) leading to a 0-35 scale. AF recurrence was defined as any documented episode of AF or atrial flutter after a blanking period of 3 months. Results The study population consisted of 306 AF patients (66% paroxysmal AF, 68% male, mean age 64±8 years). AF recurrence during 1 year follow-up occurred in 29% of paroxysmal AF patients and in 42% of persistent AF patients (p=0.021). At baseline, patient perceived AF burden was lower in paroxysmal AF patients than in persistent AF patients (18.4±3.7 vs. 20.2±5.0, p=0.001), whereas symptom severity (10.6±6.5 vs. 9.9±6.7, p=0.384) and global well-being (7.1±1.5 vs. 7.3±1.4, p=0.327) were similar. Paroxysmal AF patients reported more palpitations (2.4±1.3 vs. 1.6±1.5, p<0.001) and less shortness of breath during physical activity (1.9±1.6 vs. 2.3±1.7, p=0.048) than patients with persistent AF. Significant improvements in global well-being (0.5±1.7, p<0.001), symptom severity (3.8±7.2, p<0.001), and patient-perceived AF burden (7.2±7.5, p<0.001) were found in the entire study cohort between baseline and 1 year follow-up, without differences between paroxysmal and persistent patients (Figure). Conclusion Although persistent AF patients have a higher chance of recurrent AF after AF ablation, symptom severity and QoL improve equally in paroxysmal and persistent AF patients. These results suggest that different recommendations for AF ablation to improve symptoms in paroxysmal and persistent AF patients may not be justified.