Presenting Symptom Type and Use of Catheter Ablation in Patients with Newly Diagnosed Atrial Fibrillation

Abstract Background Atrial fibrillation (AF) frequently presents with a broad spectrum of symptoms, including non-specific complaints such as dyspnea, fatigue, dizziness, or syncope that may influence treatment decision. We examined, in patients with newly diagnosed AF, whether symptom type was associated with selection of catheter (CA) ablation and subsequent 1-year AF-specific health status. Methods We analyzed 2,848 newly diagnosed AF patients in the multicenter AF outpatient registry in 2012–2018. Presenting symptoms were categorized as palpitations, or non-palpatory symptoms (dizziness/syncope, dyspnea, or fatigue). AF-specific health status was measured at baseline and 1 year using the Atrial Fibrillation Effect on Quality-of-Life overall summary score (AFEQT-OS). Symptom-control strategies were classified as rate control, antiarrhythmic drug therapy, or CA. Multivariate models were used to evaluate factors associated with CA selection and to estimate adjusted 1-year AFEQT-OS scores according to treatment strategy and presenting symptom type. Results Mean age was 68 ± 11 years and baseline AFEQT-OS score was 77.0 ± 17.7. Non-palpatory symptoms were common, including dyspnea in 43.9%, fatigue in 37.3%, and dizziness or syncope in 33.6%. During follow-up, 38.1% of patients underwent CA. Palpitations were independently associated with selection of CA (adjusted odds ratio 1.29; 95% confidence interval, 1.03–1.61, whereas non-palpatory symptoms were not. At 1 year, CA was associated with better AF-specific health status than rate control across symptomatic subgroups, with adjusted marginal mean differences in AFEQT-OS ranging from 7.3–8.1 points. There was no evidence that the association between CA and 1-year AFEQT-OS differed according to presenting symptom type. Conclusions Palpitations may preferentially drive CA selection in newly diagnosed AF, although the association between CA and better 1-year health status was similar magnitude across the evaluated symptom profiles