Association between quality of life and redo procedures after pulmonary vein isolation in atrial fibrillation patients: Data from the Netherlands Heart Registration

Background: Atrial fibrillation (AF) significantly impacts quality of life (QoL), necessitating effective therapeutic interventions such as pulmonary vein isolation (PVI). Although PVI's success is often measured by freedom from arrhythmia, clinical practice emphasizes symptom freedom and patient comfort, as captured by QoL tools such as the Atrial Fibrillation Effect on Quality-of-Life (AFEQT) questionnaire. 

Objective: This study investigates the association between baseline QoL, changes in QoL, and redo PVI, aiming to align patient-centered outcomes with clinical decision-making. Methods: Data from 3336 AF patients undergoing first-time PVI between 2018 and 2021 in Dutch heart centers were analyzed. Patients with baseline and 1-year follow-up QoL scores were categorized into quartiles based on pre-PVI AFEQT scores, and redo PVI rates were assessed within 1 year. 

Results: Redo PVI was performed in 16.0% of patients within 1 year. Significant differences in left atrial volume index, left ventricular ejection fraction, and AF type were observed between redo and no-redo groups. Median AFEQT scores improved significantly: from 53.9 to 71.3 in redo patients and from 57.4 to 88.0 in others (P <.001). Higher baseline QoL scores correlated with lower redo rates: odds ratios for redo PVI were 0.93 (Q2, P =.52), 0.74 (Q3, P =.05), and 0.62 (Q4, P =.001) compared with Q1. Redo PVI rates varied significantly between heart centers, reflecting practice variation. 

Conclusion: Lower baseline QoL is associated with a higher likelihood of redo PVI, emphasizing the role of patient-reported outcomes in AF management. Integrating QoL assessments into routine practice may support individualized care, create risk stratification, and contribute to standardizing clinical decision-making.