Assessment of Symptoms After AF Ablation
How do the patient’s and physician’s assessments of symptoms compare 2 years after atrial fibrillation (AF) ablation?
Fifty-four patients (mean age 57 years) underwent AF ablation and implantation of an implantable loop recorder (ILR) and completed an AF-specific symptom questionnaire (AF-6) at baseline and 6, 12, and 24 months post-ablation. The AF-6 responses were compared to the physicians’ assessment of symptom severity using the European Heart Rhythm Association (EHRA) classification system. Post-ablation AF burden was documented with the ILR.
Both the mean AF-6 score and EHRA class improved significantly during follow-up. There was a weak but significant correlation between the AF-6 score and EHRA class at 12 months of follow-up, but no correlation at 24 months. The AF-6 scores and EHRA class significantly correlated with AF burden, but sometimes symptoms persisted despite an AF burden of 0 or improved despite an AF burden of 100%.
Patient-reported symptoms are more sensitive than EHRA class for assessment of clinical outcome after AF ablation. At 24 months of follow-up, these two outcome measures do not correlate. Symptom improvement can occur despite little or no effect on AF burden.
There may be several reasons for the poor correlation between a patient’s and physician’s assessment of post-AF ablation symptoms. For example, the physician (particularly the one who did the ablation) may have a bias towards maximizing the clinical benefit of the procedure, while a patient may under-report symptoms when being directly questioned, but not when completing a questionnaire. The discordance between symptoms and AF burden has been known for many years and stresses the importance of extended monitoring for objective assessment of efficacy.
Keywords: Arrhythmias, Cardiac, Atrial Fibrillation, Catheter Ablation, Heart Conduction System, Outcome Assessment (Health Care)
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