Introduction: Shared decision-making (SDM) can support patients with atrial fibrillation (AF) to evaluate treatment options for rhythm and symptom control, but studies suggest it is not occurring meaningfully in routine practice. The objective of this study was to measure decision quality and describe decision-making processes among patients and clinicians involved in decision-making around catheter ablation for AF. Methods: We conducted a cross-sectional, mixed-methods study guided by a SDM model outlining decision antecedents, processes, and outcomes. Patients and clinicians completed semi-structured interviews about decision-making around ablation, feelings of decision conflict and regret, and preferences for the content, delivery, and format of a hypothetical decision aid for ablation. Patients also completed surveys about demographic characteristics and literacy levels, AF symptoms using the University of Toronto AF Severity Scale (AFSS), and aspects of decision quality using the Controls-Preferences, Decisional Conflict, and Decision Regret scales. Surveys were analyzed using descriptive statistics and qualitative data were analyzed using directed content analysis. Results: Fifteen patients (mean age 71.1 ± 8.6 years; 27% female; mean 7.0 [SD 7.0] months since ablation) and five clinicians (three physicians, one NP, and one PA) were recruited. Most patients preferred to either share or relinquish control in medical decision-making to clinicians. For most patients, decisional conflict and regret were low, and symptoms and cardiac health generally improved after ablation. However, they also reported low levels of information and agency in the decision-making process. Most clinicians report routinely providing patients with information and encouraging engagement during consultations. Patients reported preferences for an interactive, web-based decision aid that clearly presents evidence regarding outcomes using data, visualizations, videos, and personalized risk assessments, and is available in multiple languages. Conclusions: Disconnects between clinician efforts to provide information and bolster agency and patient experiences of decision-making suggest decision aids may be needed to improve decision quality in practice. Reported experiences with current decision-making practices and preferences for decision aid content, format, and delivery can support the user-centered design and development of a decision aid.

Background: Patients with a history of mitral valve (MV) surgery can present with unique challenges during left atrial (LA) ablation due to abnormal atrial substrate and descriptions of ablation in this cohort is limited. We aim to evaluate LA ablation characteristics and outcomes in patients with a history of mitral valve surgery. Objective: We hypothesize that the success rate for ablations of LA arrhythmias in patients with prior MV surgery will be inferior to patients without prior MV surgery due to left atriopathy, presence of a MV prosthesis, and a higher burden of pre-ablation LA scar. Methods: In this single center, retrospective study, we evaluated patients who had a history of MV surgery and underwent LA ablation between January 2013 and May 2019. We analyzed baseline patient characteristics, type of MV disease and surgery, available pre-ablation voltage maps, and ablation outcomes. Results: We present a series of 20 patients who underwent a total of 30 LA ablation procedures. All 20 patients underwent pulmonary vein isolation and 11 patients also underwent ablation for LA macro-reentrant flutters. The majority of the patients (55%) were without recurrent documented arrhythmias at a mean follow-up of 22 months post-ablation. Two patients had acutely unsuccessful ablation. Conclusions: Although LA ablation in patients with previous MV surgery can be challenging due to abnormal atrial substrate and the presence of the valve prosthesis, the majority of patients in our cohort experienced atrial arrhythmia free survival at a mean follow-up of 22 months.