PMC:6019327 / 609986-611388 JSONTXT

{"project":"2_test","denotations":[{"id":"28506916-23988341-45815156","span":{"begin":1213,"end":1217},"obj":"23988341"},{"id":"28506916-23988341-45815156","span":{"begin":1213,"end":1217},"obj":"23988341"},{"id":"T48419","span":{"begin":1213,"end":1217},"obj":"23988341"},{"id":"T15641","span":{"begin":1213,"end":1217},"obj":"23988341"},{"id":"T52470","span":{"begin":1213,"end":1217},"obj":"23988341"},{"id":"T95872","span":{"begin":1213,"end":1217},"obj":"23988341"}],"text":"In recognition that AF ablation may not be curative, particularly for patients with persistent or long-standing persistent AF, the concepts of AF progression and regression, while unproven, could be of interest. Many patients might initially present with very infrequent episodes of PAF that could be quite manageable with minimal drug therapy. Ablation in this setting might help delay progression to higher burden paroxysmal or persistent AF, which could be associated with decreased functioning but also increased risks of stroke, HF, or death. On the other hand, patients with persistent AF who can be converted into infrequent, paroxysmal forms of AF (so-called AF regression) might experience not only QOL benefits but also a potential reduction in morbidity and mortality. In order for these endpoints to be widely implemented, thresholds of AF must be established under which patient QOL and risk of adverse outcomes are reliably improved, which has yet to be done. For example, one substudy of the STAR AF 1 trial showed that patients with very high-burden paroxysmal or persistent AF could continue to experience up to 2 or more hours of AF per month postablation and still report an improvement in QOL.1391 The patient-reported symptoms did not deteriorate until they experienced more than 27 hours of AF per month. This outcome remains an important focus for ongoing clinical investigation."}