Symptom Under-Recognition of Atrial Fibrillation Patients in Consideration for Catheter Ablation: A Report From the KiCS-AF Registry

Yoshinori Katsumata, Shun Kohsaka, Nobuhiro Ikemura, Ikuko Ueda, Kenji Hashimoto, Terumasa Yamashita, Hiroshi Miyama, Taishi Fujisawa, Takehiro Kimura, Kojiro Tanimoto, Yukihiko Momiyama, Masahiro Suzuki, Keiichi Fukuda, Seiji Takatsuki

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)


Objectives: This study sought to investigate whether symptom under-recognition is associated with the application of catheter ablation. Background: Atrial fibrillation (AF) symptom burden is frequently under-recognized and may affect the choice of treatment strategies. Methods: A total of 3,276 patients with AF consecutively registered in a Japanese multicenter database from 2012 to 2017 were analyzed. All patients underwent AF symptom burden assessment via the symptom and daily activities domain within the Atrial Fibrillation Effect on QualiTy-of-life (AFEQT) questionnaire. For the present analysis, 1,173 symptomatic patients (AFEQT score ≤80) with a clinical indication for catheter ablation were included. Under-recognition of symptom burden was defined as no subjective complaints checked by physicians despite self-reported AFEQT scores ≤80. Logistic regression analysis identified the predictors associated with receiving catheter ablation. Results: Of the 1,173 patients (age: 68 ± 12 years, men: 61%) analyzed, 459 underwent catheter ablation (ablation group); they had lower overall AFEQT scores (p < 0.01 for all domains) compared with the nonablation group. At the 1-year follow-up, greater improvement in the AFEQT scores was noted in the ablation group, even after adjusting for clinically relevant factors (+20.0 ± 1.2, +14.2 ± 0.9, respectively; p < 0.001). Notably, 306 (28%) patients met the criteria for symptom under-recognition, which was associated with the nonuse of catheter ablation during follow-up (odds ratio: 0.41; 95% confidence interval: 0.28 to 0.60; p < 0.001). Conclusions: Under-recognition of AF symptom burden was frequently noted and was associated with less use of catheter ablation. Standardized recognition of symptoms using the application of validated questionnaires may facilitate outcome improvement.

Original languageEnglish
Pages (from-to)565-574
Number of pages10
JournalJACC: Clinical Electrophysiology
Issue number5
Publication statusPublished - 2021 May


  • atrial fibrillation
  • catheter ablation
  • under-recognition

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)


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