It’s all about improvement of quality of life and reduction of disease burden in atrial fibrillation ablation

Correspondence to Dr Arif Elvan, Cardiology, Isala Hospitals, Zwolle, The Netherlands; a.elvan@isala.nl Atrial fibrillation (AF) is the most frequently encountered sustained cardiac arrhythmia that is associated with reduced quality of life (QOL) and increased risks of heart failure, cognitive impairment, stroke and death. The mean AFEQT score increased by 25.7, which is in line with the improvement in QOL observed in previous studies such as the CABANA trial.2–4 Although the majority of the patients included in the CABANA trial had persistent or longstanding persistent AF, the mean AFEQT score increase of 23.5 at 12 months post-ablation is very similar to the results of the VISTAX Study.2 4 Randomised clinical trials of medical and catheter ablation strategies clearly demonstrated a significant and clinically relevant improvement in QOL at 12 months after randomisation to catheter ablation compared with drug therapy.2 However, the effect of AF ablation on mortality is not well established yet. The CABANA trial failed to show significant survival benefit of catheter ablation compared with medical therapy.2 Meanwhile, symptom reduction and QOL improvement remain the primary indication for catheter ablation according to the European Society of Cardiology 2020 guidelines.1 Significant reduction of the impact of AF on healthcare utilisation and improvement of QOL metrics should be regarded as important and patient-relevant healthcare values gained by catheter ablation of paroxysmal AF. [...]Gupta and colleagues report an inverse association between the extent of QOL improvement and residual AF burden post-ablation.4 These results emphasise the importance of incorporating AF-specific QOL metrics in AF ablation studies. [...]we need to put the VISTAX Study results of point-by-point RF PVI into perspective.