Impact of Ablation Energy Sources on Perceived Quality of Life and Symptom in Atrial Fibrillation Patients: A Comparative Study

Abstract

Background: Catheter ablation is a first-line treatment for rhythm control strategies in patients with atrial fibrillation (AF), with different energy sources available, including pulsed-field ablation (PFA), high-power short-duration radiofrequency (HPSD RF), conventional radiofrequency (RF), and cryoballoon ablation. Limited evidence exists on how different ablation techniques affect patient-reported outcomes, such as patients' quality of life (QoL) and perceived symptoms. This study aims to assess the impact of ablation energy sources on reported QoL and symptom perception after AF ablation. Methods: The study included 148 patients who underwent catheter ablation in different centers. Patients were divided into four groups according to the energy source used. Follow-up was conducted during the 6 months post-procedure. Patients were asked to complete a 20-item questionnaire evaluating quality of life, activity resumption, recovery process, perceived symptoms, and satisfaction. Comparative analyses were performed across energy groups, anesthesia types, and anesthetic drugs. Results: PFA patients reported the highest improvement in QoL scores compared to RF, HPSD RF, and cryoablation (p < 0.001). Activity resumption and symptom relief were significantly better in the PFA group compared to others (p < 0.001). Anesthesia type and anesthetic drug influenced QoL outcomes, with patients under general anesthesia showing higher QoL scores compared to deep sedation (p < 0.001). The energy source and anesthetic drug resulted in independent predictors of QoL improvement. Conclusions: Ablation energy source could impact patients' perceived QoL and symptom relief after AF ablation. PFA demonstrated superior performance scores in QoL and symptom perception compared to other techniques. Anesthetic drugs also play a role in patient-reported outcomes and activity resumption.

Keywords: atrial fibrillation ablation; general anesthesia; pulsed-field ablation; quality of life; radiofrequency.

Figure 1

Boxplots illustrating patient-reported outcomes stratified by ablation energy source. The graphs display comparisons of (A) quality of life (QoL), (B) activity resumption, (C) post-ablation recovery, (D) symptom perception, (E) satisfaction, and (F) total score across four energy types: 1 = pulsed-field ablation (PFA), 2 = high-power short-duration radiofrequency (HPSD RF), 3 = conventional radiofrequency (RF), and 4 = cryoballoon ablation.

Figure 2

Diagnostic plots for linear regression model focused on patients undergoing atrial fibrillation ablation under general anesthesia with propofol and remifentanil. The plots include the following: (A) Residuals vs. Fitted values, (B) Normal Q–Q plot, (C) Scale–Location plot, and (D) Residuals vs. Leverage plot. The residuals show an approximately random scatter, suggesting linearity and homoscedasticity assumptions are met. The Q–Q plot indicates normal distribution of residuals. No influential outliers are evident based on leverage values.