Background: Among patients with persistent atrial fibrillation (peAF), magnetic resonance imaging (MRI)-guided fibrosis ablation did not reduce arrhythmia recurrence compared to PVI alone.
Aim: Our aim was to assess the determinants of symptoms and quality of life (QoL) change following ablation.
Methods: This prespecified DECAAF II analysis included patients with peAF who had symptom severity scores before and after ablation. Patients were provided with a smartphone-based ECG device for single-lead AF burden (SMURDEN) assessment. Participants completed the Atrial Fibrillation Symptom Severity (AFSS) and Short-Form 36 (SF-36) surveys at baseline, 3 months, and 12 months post-ablation. Symptom and QoL determinants were explored through univariable and multivariable linear models.
Results: Surveys from 750 patients were analyzed, revealing balanced baseline AFSS and SF-36 scores between the treatment arms (AFSS symptom score: 12.3 ± 8.2 for PVI and 12.0 ± 8.0 for MRI-guided fibrosis ablation; p = 0.670). Symptoms improved in both arms (AFSS symptom score: 6.8 ± 0.5 for PVI and 7.3 ± 0.5 for MRI-guided fibrosis ablation; p = 0.114). Patients without AF recurrence exhibited greater improvement in most of the SF-36 subcategories and AFSS subcategories (p < 0.05). SMURDEN correlated with QoL and was the only predictor of no improvement or symptom worsening (R = 0.31; p < 0.001).
Conclusion: Patients who experienced AF recurrence reported diminished symptom and QoL improvements. SMURDEN emerged as the most significant predictor of symptom improvement and was the only independent factor associated with a lack of improvement or worsening of symptoms.
Editor-in-Chief
Kalyanam Shivkumar, MD, PhD, FACC
CME Editor
Kenneth A. Ellenbogen, MD, FACC
Author
Nassir Marrouche, MD
Ghassan Bidaoui, MD
Important Dates
Date of Release: November 24, 2025
Term of Approval/Date of CME/MOC Expiration: November 23, 2026