Atrial Fibrillation Ablation in Young Adults: Measuring Quality of Life Using Patient-Reported Outcomes Over 5 Years
Brett M. Johnson, Oussama M. Wazni, Medhat Farwati, Walid I. Saliba, Pasquale Santangeli, Ruth A. Madden, Patricia Bouscher, Mina K. Chung, Mohamed Kanj, Thomas Dresing, Thomas Callahan, Mandeep Bhargava, Bryan Baranowski, John Rickard, Daniel J. Cantillon, Patrick Tchou, Jakub Sroubek, Hiroshi Nakagawa, Ayman A. Hussein
Abstract
Background: Ablation is used for both rhythm control and improved quality of life (QoL) in atrial fibrillation (AF). It has been suggested that young adults may experience high recurrence rates after ablation and data remain lacking regarding QoL benefits. We aimed to investigate AF ablation outcomes and QoL benefits in young adults undergoing AF ablation using a large prospectively maintained registry and automated patient-reported outcomes (PRO). Methods: All patients undergoing AF ablation (2013–2016) at our center were prospectively enrolled. Patients aged 50 years or younger were included. For PROs, QoL measures and symptoms were assessed at baseline, 3 months after ablation, and every 6 months thereafter. The AF severity score served as the main assessment of QoL. Results: A total of 241 young adults (age, 16–50 years) were included (17% female, 40.3% persistent AF). In all, 77.2% of patients remained arrhythmia-free during the first year of follow-up (80% in nonstructural AF and 66% in structural AF). Using PROs, 90% of patients reported improvement in QoL throughout all survey time points up to 5 years postablation ( P <0.0001). The baseline median AF severity score was 14 and improved to between 2 and 4 on all follow-up after ablation ( P <0.0001). Patients also reported fewer and shorter AF episodes, fewer emergency room visits secondary to AF, and fewer hospitalizations ( P <0.0001). Conclusions: Ablation remains an effective rhythm-control strategy in young adults with AF. Young adults also experience significant improvement in QoL with reduction of the frequency and duration of AF episodes and AF-related healthcare utilization.