Thank you for reviewing the AFib Ablation Registry Monthly Case Scenario for June 2020. This month's case scenario is focused on metric 1, proportion of patients undergoing AFib ablation with a Class I or Class II guideline-based indication. We have documentation of a patient having a successful AFib ablation procedure. When the quality team reviews the metrics and their dashboard, they see that this patient has fallen out of metric 1, which measures the proportion of patients undergoing AFib ablation with a Class I or Class II guideline-based indication. The history of the patient includes persistent AFib, palpitations with chest pain when in AFib, hypertension, TIA, a documented patient intolerance to amiodarone and flecainide in the past, and the ablation procedure was chosen as best option for rhythm control therapy. When determining the reason for a patient fallout, both the patient coding and the metric algorithm will have to be reviewed. When reviewing metrics, please use the Outcome Report Companion Guide document and use the algorithm as a guide. The document is available to be downloaded under the Resources tab, Documents, and User Guide Documents. Let's review the patient coding. The patient was inappropriately coded as being asymptomatic during AFib-A-Flutter atrial fibrillation classification coded as persistent and amiodarone as well as flecainide coded as past. When we review the algorithm of metric 1 and take into account the patient's history and coding, the patient meets most of Class II-A recommendations. The patient's coding includes pattern of AFib coded as persistent, patient's history of intolerance to at least one Class I or III antiarrhythmic, and any of the antiarrhythmics listed coded as past in pre-procedure medications. Our question is, based on the documentation and algorithm, why did the patient fall out of metric 1? Is it 1. Intolerant to antiarrhythmic drugs, 2. AFib classification coded as persistent, or 3. Coded as being asymptomatic during AFib? Please take a few seconds to review the documentation in question to determine the best answer. The answer is number 3. The patient being coded as asymptomatic during AFib in sequence 4375. When we review the metric algorithm, we have pattern of AFib coded as persistent, a Class I and a Class III antiarrhythmic medication coded past. What we do not have on the coding is symptomatic AFib. The recommendations used for metric 1 are based on the 2014 Guidelines for AFib Management document. The document is available for download under Resources, Documents, and Quality Tools and Reference Documents. Thank you for reviewing the AFib Ablation Registry Monthly Case Scenario for June 2020.

AFib Ablation Registry

metric 1

guideline-based indication

fallout

algorithm