Abstract
Background: Atrial fibrillation (AF) significantly impacts quality of life (QoL), necessitating effective therapeutic interventions such as pulmonary vein isolation (PVI). Although PVI's success is often measured by freedom from arrhythmia, clinical practice emphasizes symptom freedom and patient comfort, as captured by QoL tools such as the Atrial Fibrillation Effect on Quality-of-Life (AFEQT) questionnaire. Objective: This study investigates the association between baseline QoL, changes in QoL, and redo PVI, aiming to align patient-centered outcomes with clinical decision-making. Methods: Data from 3336 AF patients undergoing first-time PVI between 2018 and 2021 in Dutch heart centers were analyzed. Patients with baseline and 1-year follow-up QoL scores were categorized into quartiles based on pre-PVI AFEQT scores, and redo PVI rates were assessed within 1 year. Results: Redo PVI was performed in 16.0% of patients within 1 year. Significant differences in left atrial volume index, left ventricular ejection fraction, and AF type were observed between redo and no-redo groups. Median AFEQT scores improved significantly: from 53.9 to 71.3 in redo patients and from 57.4 to 88.0 in others (P < .001). Higher baseline QoL scores correlated with lower redo rates: odds ratios for redo PVI were 0.93 (Q2, P =.52), 0.74 (Q3, P =.05), and 0.62 (Q4, P =.001) compared with Q1. Redo PVI rates varied significantly between heart centers, reflecting practice variation. Conclusion: Lower baseline QoL is associated with a higher likelihood of redo PVI, emphasizing the role of patient-reported outcomes in AF management. Integrating QoL assessments into routine practice may support individualized care, create risk stratification, and contribute to standardizing clinical decision-making.
| Original language | English |
|---|---|
| Pages (from-to) | 745-752 |
| Number of pages | 8 |
| Journal | Heart Rhythm O2 |
| Volume | 6 |
| Issue number | 6 |
| Early online date | 22 Mar 2025 |
| DOIs | |
| Publication status | Published - Jun 2025 |
Bibliographical note
Publisher Copyright:© 2025 Heart Rhythm Society
Funding
The authors have no funding sources to disclose. None declared. All authors attest they meet the current ICMJE criteria for authorship. All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Mileen van de Kar, Gijs van Steenbergen and Niki Medendorp. The first draft of the manuscript was written by Mileen van de Kar and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Informed consent was waived as the study is retrospective in nature and uses anonymized data provided by the Netherlands Heart Registration. The study was performed in accordance with the Declaration of Helsinki and no ethical approval was needed according to the Dutch central committee of Human Research, as the study only used previously collected anonymized cohort registry data. Approval for this study was granted by the Committee of Research and Ethics of the Netherlands Heart Registry on 30 October 2023. The data underlying this article were provided by the Netherlands Heart Registration with the permission of the participating hospitals. Data are available on reasonable request to the corresponding author and with permission of the Netherlands Heart Registration.
| Funders | Funder number |
|---|---|
| Netherlands Heart Institute |
Keywords
- Atrial fibrillation
- Benchmarking
- Patient-centered care
- Pulmonary vein isolation
- Quality of life
- Real-world data