Impact of mobile health-detected airflow obstruction on periprocedural symptom severity and quality of life in patients with atrial fibrillation undergoing first-time ablation
K Ignaczak, M Gawlik, A Skrobucha, M Wawrzenczyk, K Rutkowski, J Szydlik, B Krzowski, C Maciejewski, M Marchel, M Peller, P Lodzinski, P Balsam, M Grabowski, L Koltowski, M GawalkoAbstract
Background
Airflow obstruction (AO) is reported to be associated with a higher risk of atrial fibrillation (AF). The presence of both conditions complicates symptom attribution and hampers accurate assessment of the symptom-resolution effectiveness of heart rhythm control interventions.
Purpose
This study aimed to assess the extent to which mobile health-detected AO affects periprocedural symptom severity and quality of life in patients with AF undergoing first-time ablation
Methods
From January to October 2024, AO screening was performed using the handheld AioCare spirometer (Healthup, Poland) in patients undergoing first-time AF ablation. Patients completed at least three spirometry attempts with up to eight allowed if initial measurements were of insufficient quality. The best acceptable result was used providing forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC) and the FEV1/FVC ratio. AO obstruction was defined as FEV1/FVC<0.70. AF recurrence was assessed using 24h-Holter electrocardiogram (ECG) monitoring and 12-lead ECG at 3-months after ablation. Quality of life and symptom severity were assessed using the SF-36, AFSS and AFEQT questionnaires before the ablation and at 3-month follow-up.
Results
Of the 128 prospectively enrolled patients (median age 64 [54-71] years; 66% men), nearly one-third (n=38) were found to have AO. Patients with and without AO were generally comparable at baseline, except for more men in the AO (vs non-AO) group (82% vs 59%, p=0.015). Also, rates of AF recurrence at 3-month follow-up were similar (21% vs 30%, p=0.387). Regarding the general health survey (SF-36), there were no statistically significant differences between groups in the physical component summary, indicating comparable physical status and physical limitations. However, patients with AO demonstrated worse mental and emotional well-being, as reflected in a lower mental component summary score (median 55 vs 62, p=0.005). According to the AF-specific symptom severity and quality-of-life questionnaires (AFSS, AFEQT), patients with AO reported less severe symptoms and better quality of life both at baseline and at follow-up compared with non-AO patients (Figure 1). However, the change in scores between baseline and follow-up was significant only for the activity domain of AFEQT score (median difference 6.5 vs 13, p=0.003), suggesting that non-AO patients experienced a greater improvement in AF-related quality of life and daily functioning following the procedure.
Conclusions
These findings may suggest that in AO patients, AF-caused activity limitations are less responsive to ablation, and the coexistence of AO contributes to a persistent symptom burden, particularly affecting mental well-being. These results support more accurate counselling and individualized post-AF ablation follow-up. Our ongoing 12-month analysis will provide further insights into the impact of AO in the post-AF ablation population.