Satisfaction of patients after first procedure of pulmonary vein isolation with cryoballoon or radiofrequency for paroxysmal atrial fibrillation (SPY-AF)

Patient satisfaction after treatment is an important factor that positively correlates with the quality of care and can influence the patient's future health choices. Both radiofrequency ablation (RFA) and cryoablation are effective techniques for pulmonary vein isolation in patients with atrial fibrillation (AF) and showed similar results in efficacy and safety, but they have not been thoroughly compared in terms of patient satisfaction.

The aim of this study is to assess the satisfaction of AF patients who underwent RFA and cryoablation for AF after their first procedure.

The sample included consecutive patients undergone the first procedure of pulmonary vein isolation with RFA or cryoablation from July 2022 to June 2023 in 8 centers. The 10-points Likert scale has been used for measuring satisfaction of the patients, evaluating anxiety before procedure, pain during and after ablation, motivation to repeat the procedure in future if necessary, real and perceived procedural time.

A total of 483 patients were enrolled. The median age was 63 (56 - 69) years and 281 (58,1%) patients were men. 385 (79,7%) patients underwent RFA and 98 (20,3%) cryoablation. Comparing RFA and cryoablation, the two techniques were equivalent in term of satisfaction of the patient, with the only exception of inguinal pain that was less in the cryoablation group (2 [0-3] vs 3 [1-4], p=0.002). Conscious sedation was used in 414 (86,7%) patients and general anesthesia in 69 (14,3%) patients. The use of general anesthesia reduced the perceived pain during and after the procedure in both techniques (p<0.05), but it resulted in lower pre-procedural anxiety only in RFA patients compared to those under conscious sedation (4 [2-6] vs 5 [3-7], p=0.007). Anesthetic management alone did not affect the willingness to repeat the procedure in RFA patients, while cryoablation patients under general anesthesia were more motivated to repeat the procedure than those under conscious sedation (10 [8-10] vs 7 [6-8], p<0.001). The perceived procedure time was shorter than the actual time in all settings.

Anesthetic management seems to have a greater impact on patient satisfaction than the technique used during ablation. Despite this, patients most motivated to repeat the procedure were those who underwent cryoablation under general anesthesia.