What are second tier outcome measures?

Edit: This is a "suppose you have this amazing, possibly non-existent, dataset" post about "what might be some other outcome measures other than nixing AF itself? and what might correlate with variations in those outcome measures?" The dataset may not exist, but apparently the US patient volume is out there, and the US is obsessed with even the slightest improvement in healthcare.

Apparently, after an initial ablation, many patients with AF have long lasting zero arrhythmia burden with no heart meds. So suppose one has deep data on 10,000 such patients. Suppose:

• they are equally healthy otherwise
• they are chadvasc = {0,1}
• they started out the same with, say, N years of Paroxysmal Lone AF
• 1st ablations yielded zero arrhythmia burden and no meds at 10 years
• (your equivalency criteria of choice)

What might be some outcome measures other than their uniformly excellent reduction in burden? and what might correlate with variations in those outcome measures?



Edited 2 time(s). Last edit at 10/07/2022 01:20PM by Kwilk.

Kwilk,

What's your point? As far as I know, there is little if any data on ablation outcomes. I would speculate that when a patient has a "successful" outcome from an ablation, that patient's Dr. may be aware of the success assuming there was continuing follow up after the ablation. But I doubt that anyone in the office is gathering outcome statistics that could be used for broad data analysis. I quote "successful" because there are few defined outcomes that identify a successful ablation other than the burden has been eliminated or reduced for some period of time.

There are numerous stories that can be found on this forum that talk about successful ablations, but they are all different.

My first ablation was "successful" for 13 years - no meds or anything for control, but my Dr. did not know about the "success" until I went back to him for a second ablation 13 years after the first. I believe that I did have a one month follow up visit, but no contact after that until 13 years later. After my second ablation with the same Dr. 2.5 years ago, there was no follow up with him because I live in another state, so he has no data on that ablation that could be part of a study.

Sorry for the confusion. I'll edit the top post to be more clear.

It's a "suppose you have this amazing, possibly non-existent, dataset" post about "what might be some outcome measures other than nixing AF itself? and what might correlate with variations in those outcome measures?"

Whether the dataset exists or not is not pertinent to my question. It starts with "suppose you have this dataset" .

Anyway, the US patient volume is out there, and the US is obsessed with even the slightest improvement in healthcare. Given the numbers of one-and-done ablatees out there, it seems to me there is obvious room for further optimization based on expanded outcome measures.

Quote
Ken
What's your point?

To expand stuff



Edited 2 time(s). Last edit at 10/07/2022 01:57PM by Kwilk.

Quote
Kwilk
It's a "suppose you have this amazing, possibly non-existent, dataset" post about "what might be some outcome measures other than nixing AF itself? and what might correlate with variations in those outcome measures?"

I am afraid that I am somewhat confused as well. The type of ablation that we are discussing here is specifically intended to "nix" Afib or flutter, so I don't know what other types of successful outcomes that there might be. The purpose is specific and limited to the "nixing." Of course, after successful nixing there could perhaps be a reduction in things like left atrial stretch over time and perhaps other symptoms that were directly caused by episodes of Afib and which might reverse after a long period of NSR.

The database doesn't exist and I don't foresee it existing any time soon, so I echo Ken's comment. I don't understand your point. Sure, if we're going to imagine a non-existent database then we can also imagine that it tracks all the things we could possibly want to know like complications, PAC/PVC burdens, heart function parameters, heart disease, dementia, strokes, quality of life measures, and so on. But that's a lot of data, not cheap to acquire, and nobody's going to pay to acquire it.

Quote
Daisy
<snip> a reduction in things like left atrial stretch over time and perhaps other symptoms that were directly caused by episodes of Afib and which might reverse after a long period of NSR.

Thanks @Daisy. So do I understand you right, that even though the arrhythmias were nixed equally well (zero burden at 10 years), on or another aspect/detail of the ablation itself might impact the extent NSR mediated reversal of the pathological remodeling that occurred due to AF episodes? If so, do you have any ablation details in mind?

Other than a reduction in burden, and only if the patients' real conditions, disorders, and diseases can be ruled out as confounds, how about recurrence over 6 months, a year, two years, five years, and finally ten years? Or a proxy would be a second ablation, and when did it take place? And then a third ablation, and so on.

Quote
gloaming
Other than a reduction in burden, and only if the patients' real conditions, disorders, and diseases can be ruled out as confounds, how about recurrence over 6 months, a year, two years, five years, and finally ten years? Or a proxy would be a second ablation, and when did it take place? And then a third ablation, and so on.

recurrence before 10 years and your other outcomes are different questions, and ruled out by the supposition that all 10000 patients were AF free and med free for the 10 years following their one-and-only ablation:

Quote
Kwilk
Apparently, after an initial ablation, many patients with AF have long lasting zero arrhythmia burden with no heart meds. So suppose one has deep data on 10,000 such patients. Suppose:

• they are equally healthy otherwise
• they are chadvasc = {0,1}
• they started out the same with, say, N years of Paroxysmal Lone AF
• 1st ablations yielded zero arrhythmia burden and no meds at 10 years
• (your equivalency criteria of choice)

What might be some outcome measures other than their uniformly excellent reduction in burden? and what might correlate with variations in those outcome measures?

Quote
Kwilk
So do I understand you right, that even though the arrhythmias were nixed equally well (zero burden at 10 years), on or another aspect/detail of the ablation itself might impact the extent NSR mediated reversal of the pathological remodeling that occurred due to AF episodes? If so, do you have any ablation details in mind?

I don't know enough about it to comment on this. The assumption I had was that simply the experience of extended NSR might, over time, reverse some of the remodeling caused by a history of Afib episodes. For instance, my hope is that my mild left atrial stretch will improve if my ablation is successful and I remain in NSR for an extended time. Time will tell.

Thanks @Daisy, there is some data on reversal, but not much as far as I found, and none (that I've been able to find yet) regarding how the details of the ablation procedure might help or hinder the reversal. Hope yours goes well.