Determinants of symptom relief and quality of life improvement after atrial fibrillation ablation

Aims The primary goal of atrial fibrillation (AF) ablation is to improve AF-related symptoms and quality of life. Previous studies have observed a discrepancy between objective recurrence of AF after ablation and patient-perceived change of symptoms. Although predictors of freedom of AF recurrence after AF ablation have been widely studied, factors associated with symptom relief and quality of life improvement remain underexplored. The present study aimed to investigate determinants of symptom reduction and improvement in quality of life after AF ablation. Methods and results A total of 382 AF patients (68% paroxysmal AF, 67% male, mean age 63 ± 9 years) undergoing AF ablation were included. Patient-reported outcomes were assessed using the Toronto Atrial Fibrillation Severity Scale (AFSS) and 36-Item Short-Form Health Survey (SF-36) score. Patients completed both the AFSS and SF-36 score pre-ablation, and post-ablation at 4 months and 1 year follow-up. Atrial tachyarrhythmia recurrence was documented in 139 patients (36%) at 1 year follow-up. AF symptom severity, patient-perceived AF burden and quality of life improved from baseline to 1 year follow-up, particularly in patients without atrial tachyarrhythmia recurrence. Greater baseline AFSS-derived symptom severity and patient-perceived AF burden were associated with a greater improvement of AF symptom severity and patient-perceived AF burden after ablation. Conclusion This study shows that patients with lower quality of life and greater AF symptom severity and patient-perceived AF burden benefit most from AF ablation, suggesting that more emphasis should be put on the burden of AF symptoms in clinical decision-making.