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Effect of Outcome Measures on the Apparent Efficacy of Ablation for Atrial Fibrillation: Why "Success" is an
Nicholas Jackson1, Ehsan Mahmoodi1, Jim Leitch1
1Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia; The University of Newcastle, Newcastle, NSW, Australia.
Insights
Patient-defined success for atrial fibrillation (AF) ablation differs from standard measures. Many patients accept recurrences or repeat procedures, impacting perceived AF ablation benefits.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Device Technology
Background:
- Atrial fibrillation (AF) ablation success rates vary based on endpoint criteria, follow-up duration, and completeness.
- Standardized definitions are crucial for accurately assessing AF ablation benefits.
Purpose of the Study:
- To compare different endpoint criteria for atrial fibrillation (AF) recurrence post-ablation.
- To evaluate patient perspectives on successful AF ablation outcomes.
Main Methods:
- Defined 'Strict', 'Liberal', and 'Patient-defined Outcome' endpoints for AF recurrence in 200 patients.
- Surveyed 50 patients awaiting AF ablation regarding their success criteria.
Main Results:
- Five-year freedom from atrial tachyarrhythmias (AT) was 62% (Strict), 73% (Liberal), and 80% (Patient-defined).
- 70% of surveyed patients accepted repeat procedures, and 76% accepted recurrences.
Conclusions:
- Patient-defined success criteria for AF ablation yield significantly different results than conventional measures.
- A majority of patients consider AF ablation successful with up to two recurrences or one repeat procedure.
Introduction:
Different endpoint criteria, different durations of follow-up and the completeness of follow-up can dramatically affect the perceived benefits of atrial fibrillation (AF) ablation.
Methods:
We defined three endpoints for recurrence of AF post ablation in a cohort of 200 patients with symptomatic AF, refractory to antiarrhythmic drugs (AADs). A 'Strict Endpoint' where patients were considered to have a recurrence with any symptomatic or documented recurrence for ≥30 seconds with no blanking period, and off their AADs, a 'Liberal Endpoint' where only documented recurrences after the blanking period, either on or off AADs were counted, and a 'Patient-defined Outcome endpoint' which was the same as the Liberal endpoint but allowed for up to two recurrences and one repeat ablation or DCCV during follow-up. We also surveyed 50 patients on the waiting list for an AF ablation and asked them key questions regarding what they would consider to be a successful result for them.
Results:
Freedom from recurrence of atrial tachyarrhythmias (AT) at 5 years was 62% for the Strict Endpoint, 73% for the Liberal Endpoint, and 80% for the Patient-defined Outcome endpoint (p<0.001). Of the 50 patients surveyed awaiting AF ablation, 70% said they would still consider the procedure a success if it required one repeat ablation or one DCCV (p=0.004), and 76% would be accepting of one or two recurrences during follow-up (p<0.001).
Conclusion:
In this study, the majority of patients still considered AF ablation a successful treatment if they had up to two recurrences of AF, one repeat procedure or one DCCV. Furthermore, a 'Patient-defined' definition of success lead to significantly different results in this AF ablation cohort when compared to conventionally used/guideline directed measures of success.
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