Ablation Effective for Rhythm Control in Young Adults With AF

About 90% of young adults with atrial fibrillation (AF) have improved quality of life (QOL) after 5 years following ablation for rhythm control based on automated patient-reported outcomes (PRO), according to findings published in Circulation: Arrhythmia and Electrophysiology.

Using a prospective AF registry, researchers evaluated AF ablation outcomes and QOL benefits in young adults who had received catheter ablation. Patients who had received ablation at a single center from 2013 to 2016 with either radiofrequency (RF) or cryoablation targeting isolation of the pulmonary veins were included in the study.

An automated remote follow-up system was created for PRO data collection and QOL measures in the patients, mainly with the AF severity score (AFSS). The PRO system automatically sent an email invitation to patients to complete a survey 10 days before the scheduled ablation procedure, as well as at 3 and 6 months following the procedure and every 6 months after for a duration of 5 years.

A total of 241 patients aged 16 to 50 years received AF ablation. They had a mean age of 43.1±7.3 years and 83% were men. Ablation was performed for paroxysmal AF in 59.3% of patients and 40.3% had ablation for persistent AF.

In 1 year of follow-up, 77.2% of patients were arrhythmia-free. Among those without structural heart disease, 80% remained arrhythmia-free at 1 year and 66% of those with structural heart disease were arrhythmia-free after 1 year. For patients who had paroxysmal AF, 78.3% remained arrhythmia-free at 1-year follow-up vs 75.3% of patients with persistent AF.

The participants answered an average of 3.34 surveys and significant QOL improvement occurred following ablation. The median AFSS was 14 (7-22) at baseline and decreased to 4 or less for all time points during follow-up (P <.0001).

The participants with RF ablation also had a baseline median AFSS of 14 (7-22), which was lowered to 4 or less at all time points (P <.0001), and those who had cryoablation had a median AFSS of 9 (9-9) at baseline with a decreased score of 6 or less at all time points.

Overall, about 75.0% of the patients reported marked improvement in AF symptoms after ablation, 11.5% reported moderate improvement after ablation, 6.6% reported mild improvement after ablation, and 7.0% reported no improvement after ablation (P <.0001). At 12 months, 73.8% (n=59) of patients reported marked improvement, 18.8% (n=15) reported mild-to-moderate improvement, and 7.5% (n=6) reported worse or no change in symptoms after ablation. Health care use, including emergency department visits and hospitalizations, also significantly decreased postablation.

The investigators noted some limitations, including the observational nature of the study, and that asymptomatic recurrences could be missed with PROs. In addition, the participants were part of a single-referral center that mostly performed RF ablation and may not be representative of community practice. Furthermore, the population was predominantly obese, White, non-Hispanic male patients, and the PRO survey may have led to selection bias with more satisfied patients completing the survey than those less satisfied.

“AF ablation remains a durable tool for rhythm-control strategies in young adults with AF,” wrote the researchers. “In addition to typical outcomes of arrhythmia-free survival, young adults also experience significant improvement in QOL, symptoms, and AF-related healthcare utilization.”

Disclosure: Some of the study authors declared affiliations with a medical technology company. Please see the original reference for a full list of disclosures.