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Randomized Controlled Trial
. 2024 May 2;26(5):euae104.
doi: 10.1093/europace/euae104.

Comprehensive atrial fibrillation burden and symptom reduction post-ablation: insights from DECAAF II

Charbel Noujaim  1 , Ala Assaf  1 , Chanho Lim  1 , Han Feng  1 , Hadi Younes  1 , Mario Mekhael  1 , Nour Chouman  1 , Ghaith Shamaileh  1 , Abdel Hadi El Hajjar  1 , Tarek Ayoub  1 , Nino Isakadze  2 , Mihail G Chelu  3   4   5   6 , Nassir Marrouche  1 , Eoin Donnellan  1
Affiliations
Randomized Controlled Trial

Comprehensive atrial fibrillation burden and symptom reduction post-ablation: insights from DECAAF II

Charbel Noujaim et al. Europace. .

Abstract

Aims: Traditional atrial fibrillation (AF) recurrence after catheter ablation is reported as a binary outcome. However, a paradigm shift towards a more granular definition, considering arrhythmic or symptomatic burden, is emerging. We hypothesize that ablation reduces AF burden independently of conventional recurrence status in patients with persistent AF, correlating with symptom burden reduction.

Methods and results: Ninety-eight patients with persistent AF from the DECAAF II trial with pre-ablation follow-up were included. Patients recorded daily single-lead electrocardiogram (ECG) strips, defining AF burden as the proportion of AF days among total submitted ECG days. The primary outcome was atrial arrhythmia recurrence. The AF severity scale was administered pre-ablation and at 12 months post-ablation. At follow-up, 69 patients had atrial arrhythmia recurrence and 29 remained in sinus rhythm. These patients were categorized into a recurrence (n = 69) and a no-recurrence group (n = 29). Both groups had similar baseline characteristics, but recurrence patients were older (P = 0.005), had a higher prevalence of hyperlipidaemia (P = 0.007), and had a larger left atrial (LA) volume (P = 0.01). There was a reduction in AF burden in the recurrence group when compared with their pre-ablation burden (65 vs. 15%, P < 0.0001). Utah Stage 4 fibrosis and diabetes predicted less improvement in AF burden. The symptom severity score at 12 months post-ablation was significantly reduced compared with the pre-ablation score in the recurrence group, and there was a significant correlation between the reduction in symptom severity score and the reduction in AF burden (R = 0.39, P = 0.001).

Conclusion: Catheter ablation reduces AF burden, irrespective of arrhythmia recurrence post-procedure. There is a strong correlation between AF burden reduction and symptom improvement post-ablation. Notably, elevated LA fibrosis impedes AF burden decrease following catheter ablation.

Keywords: AF burden; AF symptoms; Atrial fibrillation; Catheter ablation; Fibrosis; Smartphone ECG.

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Conflict of interest statement

Conflict of interest: N.M. reported Marrek (founder) and ECG Check (previous shareholder) outside the submitted work; a patent was issued for MRI fibrosis imaging. No other disclosures were reported.

Figures

Graphical Abstract
Graphical Abstract
Figure 1
Figure 1
Atrial fibrillation burden reduction in patients who had recurrent atrial arrhythmia after catheter ablation. The grey lines represent individual patients.
Figure 2
Figure 2
Correlation between atrial fibrillation burden variation and symptom severity variation.
See this image and copyright information in PMC

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