Characterizing atrial fibrillation symptom improvement following de novo catheter ablation.

Overview

abstract

AIM: Atrial fibrillation (AF) symptom relief is a primary indication for catheter ablation, but AF symptom resolution is not well characterized. The study objective was to describe AF symptom documentation in electronic health records (EHRs) pre- and post-ablation and identify correlates of post-ablation symptoms. METHODS AND RESULTS: We conducted a retrospective cohort study using EHRs of AF patients (n = 1293) undergoing ablation in a large, urban health system from 2010-2020. We extracted symptom data from clinical notes using a natural language processing algorithm (F score: 0.81). We used Cochran's Q tests with post-hoc McNemar's tests to determine differences in symptom prevalence pre- and post-ablation. We used logistic regression models to estimate the adjusted odds of symptom resolution by personal or clinical characteristics at 6- and 12-months post-ablation. In fully adjusted models, at 12 months post-ablation patients, patients with heart failure had significantly lower odds of dyspnea resolution (odds ratio [OR] 0.38, 95% confidence interval [CI] 0.25-0.57), edema resolution (OR 0.37, 95% CI 0.25-0.56), and fatigue resolution (OR 0.54, 95% CI 0.34-0.85), but higher odds of palpitations resolution (OR 1.90, 95% CI 1.25-2.89) compared to those without heart failure. Age 65 and older, female sex, Black or African American race, smoking history, and anti-arrhythmic use were also associated with lower odds of resolution of specific symptoms at 6 and 12 months. CONCLUSION: Symptom patterns post-ablation are heterogeneous. Findings warrant confirmation with larger, more representative datasets, which may be informative for patients whose primary goal for undergoing an ablation is symptom relief.