Language
English
Publication Date
5-2-2024
Journal
EP Eurospace
DOI
10.1093/europace/euae104
PMID
38646912
PMCID
PMC11077606
PubMedCentral® Posted Date
4-22-2024
PubMedCentral® Full Text Version
Post-print
Abstract
Aims: Traditional atrial fibrillation (AF) recurrence after catheter ablation is reported as a binary outcome. However, a paradigm shift towards a more granular definition, considering arrhythmic or symptomatic burden, is emerging. We hypothesize that ablation reduces AF burden independently of conventional recurrence status in patients with persistent AF, correlating with symptom burden reduction.
Methods and results: Ninety-eight patients with persistent AF from the DECAAF II trial with pre-ablation follow-up were included. Patients recorded daily single-lead electrocardiogram (ECG) strips, defining AF burden as the proportion of AF days among total submitted ECG days. The primary outcome was atrial arrhythmia recurrence. The AF severity scale was administered pre-ablation and at 12 months post-ablation. At follow-up, 69 patients had atrial arrhythmia recurrence and 29 remained in sinus rhythm. These patients were categorized into a recurrence (n = 69) and a no-recurrence group (n = 29). Both groups had similar baseline characteristics, but recurrence patients were older (P = 0.005), had a higher prevalence of hyperlipidaemia (P = 0.007), and had a larger left atrial (LA) volume (P = 0.01). There was a reduction in AF burden in the recurrence group when compared with their pre-ablation burden (65 vs. 15%, P < 0.0001). Utah Stage 4 fibrosis and diabetes predicted less improvement in AF burden. The symptom severity score at 12 months post-ablation was significantly reduced compared with the pre-ablation score in the recurrence group, and there was a significant correlation between the reduction in symptom severity score and the reduction in AF burden (R = 0.39, P = 0.001).
Conclusion: Catheter ablation reduces AF burden, irrespective of arrhythmia recurrence post-procedure. There is a strong correlation between AF burden reduction and symptom improvement post-ablation. Notably, elevated LA fibrosis impedes AF burden decrease following catheter ablation.
Keywords
Aged, Female, Humans, Male, Middle Aged, Atrial Fibrillation, Catheter Ablation, Electrocardiography, Recurrence, Risk Factors, Severity of Illness Index, Time Factors, Treatment Outcome, Prospective Studies, Atrial fibrillation, AF burden, Smartphone ECG, Catheter ablation, Fibrosis, AF symptoms
Published Open-Access
yes
Recommended Citation
Noujaim, Charbel; Assaf, Ala; Lim, Chanho; et al., "Comprehensive Atrial Fibrillation Burden and Symptom Reduction Post-Ablation: Insights From Decaaf II" (2024). Faculty and Staff Publications. 4215.
https://digitalcommons.library.tmc.edu/baylor_docs/4215
Graphical Abstract