Is frailty associated with greater symptom burden following catheter ablation for atrial fibrillation?
Authors: Nielsen N , Westergaard L M , Joens C , Kristensen S L , Johannessen A , Sandgaard N , Gang U J O , Hansen P S , Kristiansen S B , Fosboel E L , Koeber L , Pehrson S , Chen X , Jacobsen P K , Weeke P E 
Published: November 2023

Abstract

Background
Previous, small studies have found that the effectiveness of catheter ablation among patients with atrial fibrillation (AF) is affected by frailty. However, whether the symptom burden after catheter ablation varies according to frailty remains uncertain.

Purpose
We aimed to assess whether severity of patient frailty modified the recurrence of AF in the year after first-time catheter ablation for AF including proportion of hospital admissions with AF.

Methods
We identified patients with a first-time catheter ablation for AF (Jan. 1st 2010-Dec. 31st 2018) from the Danish National Ablation Registry, and eligible for one year of follow-up. Patient comorbidities and concomitant pharmacotherapy were identified using Danish nationwide registries. The patients’ Hospital Frailty Risk Score was calculated using diagnosis codes, and patients were grouped according to cut points of low (&lt;5), intermediate (5-10), and high-risk (&gt;10) frailty. Multivariable Cox proportional-hazards analyses were performed for comparison of associated factors for the risk of recurrence of AF during one year of follow-up after a 3-month blanking period. McNemars test was used for comparison of AF hospital admission rates before and after catheter ablation.

Results
Among 3,638 patients treated with first-time catheter ablation for AF (median age 62.4 years [Q1,Q3=55.1,68.5 years], 72.8% male), 89.0% had low-risk frailty, 9.4% had intermediate-risk frailty and 1.6% had high-risk frailty. At one year follow-up, 546 (15.0%) patients had recurrence of AF (hospital admission with AF or treatment with electrical cardioversion). Both intermediate-risk frailty patients (HR 1.56, CI: 1.22-2.00, p&lt;0.001) and high-risk frailty patients (HR 2.13, CI: 1.30-3.49, p=0.003) had a significantly increased risk of recurrence of AF during one year of follow-up compared with patients with a low-risk frailty score. All patients across frailty groups had a 5-fold decrease in AF hospital admissions in the year after catheter ablation (15%) compared with the year before (68%) (p&lt;0.001). Patients with high-risk frailty had a more than 3-fold reduction of AF hospital admissions in the year after catheter ablation (28%) compared with the year before (88%) (p&lt;0.001) (Figure 1). During one year follow-up, 35 patients (1.0%) died.

Conclusion
Patients with high-risk frailty had a 3-fold decrease while all patients across frailty groups had a 5-fold decrease in AF hospital admissions in the year after catheter ablation compared with the year before. Thus, indicating a lower symptom burden after catheter ablation. Nevertheless, intermediate-risk and high-risk frailty was associated with significantly higher recurrence rates of AF one year after first-time catheter ablation for AF compared with low-risk frailty patients. Patient frailty should be considered when selecting patients eligible for ablation in order to improve patient outcomes.