Background - Atrial fibrillation (AF) ablation targets improvement in quality of life (QoL). Data is scarce on predictors of QoL improvement following ablation. We aimed to investigate the clinical characteristics underlying differential response in QoL after AF ablation (with or without arrhythmia recurrence). Methods - All patients undergoing AF ablation (2013-2016) at our center were prospectively enrolled in a fully automated patient-reported outcomes registry. A large number of variables were collected including AF symptom severity scale (AFSSS) and AF burden (as indicated by AF frequency and duration scores). Patients were divided into 3 groups based on self-report of QoL improvement: remarkable (super responders), mild/moderate, and unchanged or worse (non-responders). Univariable and multivariable logistic regression models assessed clinical characteristics and QoL outcomes. Results - A total of 956 patients were included (25% females, mean age 63.9). Most patients (~80%) were super responders (n=761), 138 (14.4%) had mild/moderate improvement, and 57 (5.9%) were non-responders. The strongest predictors of remarkable QoL improvement were freedom of arrhythmia recurrence (OR 2.42, 95% CI 1.27-4.59, p-value = 0.007), and lower AF burden at 12 months. Similarly, higher AF burden was significantly associated with clinical "non-response". In patients with observed clinical recurrence-QoL mismatch, changes in AF burden at 12 months were the main predictors of QoL outcome, with lower burden predicting higher improvement in QoL and vice versa. Conclusions - Most patients derive significant QoL benefit from AF ablation. Freedom from arrhythmia recurrence and lower AF burden predict remarkable QoL improvement following ablation.

Introduction Catheter ablation for atrial fibrillation (AF) is frequently used for the purpose of rhythm control and improved quality of life (QoL). Although success rates are high, a significant proportion of patients require redo ablation. Data are scarce on patient‐centered outcomes and QoL in patients undergoing redo AF ablation. We aimed to assess QoL and clinical outcomes using a large prospectively maintained patient‐reported outcomes (PRO) registry. Methods All patients undergoing redo AF ablation (2013–2016) at our center were enrolled in a prospective registry for outcomes and assessed for QoL using automated PRO surveys (baseline, 3 and 6 months after ablation, every 6 months thereafter). Data were collected over 3 years of follow‐up. The atrial fibrillation symptom severity scale (AFSSS) was used as the main measure for QoL. Additional variables included patient‐reported improvement, AF burden, and AF‐related healthcare utilization including emergency room (ER) visits and hospitalizations. Results A total of 848 patients were included (28% females, mean age 63.8, 51% persistent AF). By automated PRO, significant improvement in QoL was noted (baseline median AFSSS of 12 [5–18] and ranged between 2 and 4 on subsequent assessments; p < .0001), with ≥70%of patients reported remarkable improvement in their AF‐related symptoms. The proportion of patients in AF at the time of baseline survey was 36%, and this decreased to <8% across all time points during follow‐up (p < .0001). AF burden was significantly reduced (including frequency and duration of episodes; p < .0001), with an associated decrease in healthcare utilization after 6 months from the time of ablation (including ER visits and hospitalizations; p < .0001). The proportion of patients on anticoagulants or antiarrhythmics decreased on follow‐up across all time points (p < .0001 for all variables). Conclusion Most patients derive significant QoL benefit from redo AF ablation; with reduction of both AF burden and healthcare utilization.

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