Underrecognition of AF Symptom Burden Found to Be Associated With Catheter Ablation Underuse

Atrial fibrillation (AF) symptom burden was found to be frequently underrecognized and to be associated with underutilization of catheter ablation, according to a study published in the Journal of the American College of Cardiologists: Clinical Electrophysiology.

In this study, data were obtained from the Keio interhospital Cardiovascular Studies-AF (KiCS-AF) registry for the 2012 to 2017 period. The data of 1173 patients (mean age, 68±12 years; 61% men; average body mass index, 23±4 kg/m²) with symptomatic AF were examined. Patients were assessed using the AF Effect on QualiTy-of-life (AFEQT) questionnaire and approximately 150 clinical variables were examined, including demographic and prescription and echocardiography history.

In this cohort, mean heart rate 79±19 beats per min, 6% had new onset AF, 52% paroxysmal AF, 25% persistent AF, and 15% permanent AF.

Patients who received (n=459) vs did not receive (n=714) catheter ablation were found to be younger, to have higher body mass index and lower heart rate, lower rates of diabetes, heart failure, malignancy (P <.001 for all), of coronary artery disease (P =.002), hypertension (P =.005), previous stroke or transient ischemic attack (P =.03), and were more likely to receive antiarrhythmic drugs on arrival (P <.001).

Patients who received vs did not receive ablation had higher rates of paroxysmal AF (68% vs 43%, respectively; P <.001), smaller left atrial diameter (3.9±0.7 vs 4.2±0.8 cm, respectively; P <.001), and lower left ventricular ejection fraction (58%±7% vs 56%±10%, respectively; P <.001).

Patients who received vs did not receive catheter ablation had milder treatment concerns (median, 67 vs 72, respectively; P <.001), symptoms (median, 63 vs 75, respectively; P <.001), and treatment satisfaction (median, 50 vs 67, respectively; P <.001) at baseline, as indicated by responses on AFEQT questionnaires, and were more likely to describe symptoms of palpitation, irregular heartbeat, and lightheadedness, and to report engaging in vigorous activities and to be more concerned about sudden escalation of their AF symptoms (P <.05 for all).

At a 1-year follow-up, total AFEQT scores improved in the cohort (P <.001), with a greater improvement in AFEQT scores at the 1-year follow-up in the ablation vs nonablation group observed after adjusting for clinical factors (P <.001).

Patients less likely to receive a catheter ablation were older (>75 years; odds ratio [OR], 95% CI, 0.03-0.47; P <.001), more likely to be women (OR, 0.58; 95% CI, 0.44-0.78; P <.001), had congestive heart failure (OR, 0.27; 95% CI, 0.18-0.40; P <.001), underrecognized symptoms (OR, 0.42; 95% CI, 0.30-0.60; P <.001), and had a malignancy (OR, 0.11; 95% CI, 0.03-0.47; P =.003).

Study limitations include the fact that economic status and frailty which may have been significant barriers to receiving catheter ablation were not evaluated.

 “Underrecognition of symptoms by physicians was associated with fewer catheter ablation procedures and may lead to poorer symptom control,” concluded the study authors. “Standardizing clinical recognition of AF-related symptoms using questionnaires may reduce underrecognition and facilitate an improvement of outcomes.”

Reference

Katsumata Y, Kohsaka S, Ikemura N, et al. Symptom Underrecognition of Atrial Fibrillation Patients in Consideration for Catheter Ablation: A Report From the Kics-AF Registry. JACC Clin Electrophysiol. 2020;S2405-500X(20)31122-1. doi:10.1016/j.jacep.2020.10.016.