(ASPOT11) Evaluation of ablation workflow for Paroxysmal and Persistent Atrial Fibrillation Treatment using electronic health record linked with digital health data

Background: Digital health data is an importance source of real-world data. Linking digital health data with electronic health record could allow us evaluate workflow and outcome of medical procedures.

Objectives: To compare the difference in procedural characteristics and outcomes between paroxysmal (PAF) and persistent (PsAF) atrial fibrillation using linked data

Methods: Among AF patients undergoing the first RFA, digital procedural data stored and analyzed by CARTONET platform were linked to Mercy electronic health record (EHR) data. Mercy health operates in four states in Midwest US, with over 40 hospitals and 12 outpatient surgery centers. The following digital procedural parameters: number of ablation lesions and averages of contact force [gr], stability [mm], maximum power [W], and ablation duration [minutes] were calculated at each anatomical site or ablation line. AF recurrence within 1 year post ablation was defined as a composite of repeat ablation, direct cardioversion (DCCV), and AF hospitalization using diagnostic and procedural codes in the EHR. Statistical comparisons were conducted between PAF and PsAF on ablation characteristics and AF recurrence.

Results: Among 303 patients with PSAF (51%) or PAF (49%) treated in 2017 and 2018, all had both right and left wide antral circumferential ablation (WACA) ablations. However, more PSAF vs PAF patients had ablations in the right carina (68.4% vs 52.7%), roof line (53.5 % vs 38.5%), and posterior line (27.7% vs 16.2%) atrial locations. Procedural duration was longer for PSAF vs PAF (144 vs 122 minutes, p< 0.001), as was mapping time (83 vs 71 min) and ablation duration (61 vs 50 min). Ablation lesions number were higher in PSAF vs PAF for overall left WACA area (71 vs 58) and sub locations of left posterior (23 vs 18), left inferior (16 vs 12), and left ridge (17 vs 13), as well as roof line (19 vs 11) and right carina (10 vs 7). PSAF vs PAF had consistently higher contact force and power within right and left WACA. PSAF had higher proportion AF recurrence (composite: 32% vs 11%, repeat ablation: 7.1% vs 1.4%, DCCV: 25.8% vs 9.5%, AF hospitalization: 8.4% vs 2.7%) than PAF.

Conclusions: Linking digital health data with electronic health record allow us to evaluate difference in ablation procedural characteristics between PSAF and PAF, PSAF had more ablations done outside of WACA area, longer ablation duration, more ablation lesions, higher contact force and power.