Patient-reported quality of life after atrial fibrillation ablation: a real-world study

Background

Patients with atrial fibrillation (AF) often experience reduced quality of life (QoL), making patient-reported outcome measures (PROMs) essential in patient-centred care. Although catheter ablation improves symptoms, PROM-based QoL outcomes remain variably reported. We assessed changes in AF-related QoL in a population submitted to AF ablation using the AF Effect on Quality-of-Life (AFEQT) questionnaire.

Methods

Consecutive patients undergoing catheter ablation for AF were invited and prospectively enrolled between 2023 and 2025. QoL was assessed at baseline on the day of ablation (prior to the procedure) and at 1, 3, 6, 12, 18, and 24 months post-ablation. The AFEQT questionnaire includes 20 items scored from 1 to 7 and converted to a 0–100 scale, where 0 represents severely impaired QoL and 100 represents no negative QoL impact.

We assessed the change in AFEQT overall score from baseline to follow-up. A clinically meaningful improvement was defined as a >5-point increase in the overall score. A 7-day Holter was performed at discharge to detect early recurrence, and AF recurrence during follow-up was assessed using Holter or 12-lead ECG. Procedural and safety outcomes were recorded.

Results

Of 204 included patients, 153 completed at least one AFEQT questionnaire at follow-up and were analysed (age 62 ± 11 years; 95 men; 43% paroxysmal AF). Energy source was pulsed-field ablation in 65 patients (43%) and the majority (n = 84, 54%) underwent pulmonary vein isolation only. No major adverse events were observed until discharge. ER on the 7-day Holter occurred in 17 patients (11%).

After AF ablation, AFEQT scores increased progressively from baseline to 2-year follow-up (Figure 1A). After a mean follow-up of 14±4 months, the overall AFEQT score improved significantly (53±23 to 71±22; 95% CI 14.654–21.632; p<0.001) (Figure 1B). Most patients (n = 109, 71%) achieved a clinically meaningful QoL improvement (>5-point AFEQT increase) (Figure 1C).

AF recurrence at follow-up was observed in 28% (n=43) of the patients. Importantly, QoL also improved significantly in this subgroup (54±23 to 67±22; 95% CI 6.927–19.670; p<0.001), with 66% achieving a clinically meaningful improvement, suggesting symptomatic benefit despite intermittent arrhythmia recurrence.

Conclusion

In a real-world cohort of AF ablation patients, PROM-based AFEQT assessment showed a significant improvement in QoL over time, irrespective of recurrency status, with most patients achieving a clinically meaningful benefit and low rates of early recurrence on systematic monitoring. These findings support the routine feasibility and clinical value of integrating PROMs into post-ablation follow-up.