Positive Clinical Benefit on Patient Care, Quality of Life, and Symptoms After Contact Force–Guided Radiofrequency Ablation in Persistent Atrial Fibrillation

Abstract

Background: There is limited evidence on the long-term clinical benefits of catheter ablation in patients with persistent atrial fibrillation. Methods: PRECEPT was a prospective, multicenter, single-arm Food and Drug Administration–regulated investigational device exemption clinical study. Patients were followed up to 15 months after ablation. Outcomes included use of antiarrhythmic drugs, rate of cardioversions and cardiovascular hospitalization, Atrial Fibrillation Effect on Quality-of-Life score, and Canadian Cardiovascular Society Severity of Atrial Fibrillation score. Results: A total of 333 enrolled persistent atrial fibrillation patients underwent ablation. The cardioversion rate decreased by 83% at the 9- to 15-month follow-up. Antiarrhythmic drug utilization decreased by 69% at 12 to 15 months post-ablation. The Kaplan-Meier estimate of freedom from cardiovascular hospitalization was 84.2% (95% CI, 80.2%–88.2%) at 15 months. Consistent improvements in mean Atrial Fibrillation Effect on Quality-of-Life composite (+50.0) were seen at 6 months, sustained at 15 months, and exceeded the minimum clinically important difference. Improvements in Atrial Fibrillation Effect on Quality-of-Life scores were significantly better among participants without documented atrial arrhythmia recurrences. By Canadian Cardiovascular Society Severity of Atrial Fibrillation symptom classification, >80% of patients were asymptomatic (class 0) at 15 months post-ablation compared with only 0.7% at baseline. Conclusions: Contact force–guided radiofrequency ablation of persistent atrial fibrillation was associated with a significant decrease in antiarrhythmic drug use, cardioversion rate, and hospitalization. Clinically meaningful improvements in quality of life were observed in all patients. The majority of the patients (>80%) were asymptomatic at 15 months post-ablation. The positive clinical impact of improved quality of life and reduced health care utilization may help with shared decision-making in persistent atrial fibrillation treatment. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02817776.

Atrial fibrillation symptom reduction and improved quality of life following the hybrid convergent procedure: a CONVERGE trial subanalysis

“…Our findings regarding QOL, support previously published QOL data from several studies of patients with PersAF treated with various endocardial ablation strategies ( 10 , 12 ). In several studies, the improvements in QOL have been attributed to and associated with the reduction in AF burden ( 3 , 6 , 13 , 19 ).…”

“…CA to isolate the pulmonary veins (PV) is effective in the treatment of patients with paroxysmal AF (i.e., AF that terminates within 7 days) ( 7 - 9 ). Recent investigational device exemption (IDE) clinical trials reported favorable outcomes following the use of cryoballoon and radiofrequency CA in the treatment of patients with early PersAF less than 6 months ( 10 ) and PersAF less than 12 months ( 11 ), with improvements in AF-related symptoms and QOL in post-procedure follow-up ( 10 , 12 ). Patients with persistent AF (PersAF) and longstanding PersAF (LSPAF) may tolerate their symptoms better than patients with paroxysmal AF because of living with the condition for a prolonged period.…”

Extensive Posterior Wall Isolation on Top of Pulmonary Vein Isolation Guided by Ablation Index in Persistent Atrial Fibrillation Ablation

“…Furthermore, previous studies have shown a high reconnection rate when PWI was performed using a “box” lesion with 20 to 35 watts. In contrast to CAPLA, the PRECEPT study reported a single-procedure success rate in Pe-AF patients of 80.4% at 15 months, with subsequent improvement in the patients’ quality of life and reduction in hospitalization, which is likely to be due to the different ablation techniques used [ 27 , 28 ].…”

High-Power Short-Duration Lesion Index-Guided Posterior Wall Isolation beyond Pulmonary Vein Isolation for Persistent Atrial Fibrillation

“…Indeed, previous studies have reported a high reconnection rate when PWI is carried out using a “box” lesion set and low power (20–35 W). In contrast to CAPLA, the PRECEPT study reported a single-procedure success rate in Pe-AF of 80.4% at 15 months, with subsequent improvement in quality of life and a reduction in hospitalization, likely due to different ablation techniques [ 34 , 35 ]. Winkle et al reported a large real-world evaluation of the combination of HPSD and CF sensing catheters [ 36 ].…”