Archief Roodbont

Abstract and Introduction

Abstract

Objectives We sought to determine the relationship between atrial fibrillation (AF) ablation efficacy, quality of life (QoL), and AF-specific symptoms at 2 years.
Background Although the primary goal of AF ablation is QoL improvement, this effect has yet to be demonstrated in the long term.
Methods A total of 502 symptomatic AF ablation recipients were prospectively followed for recurrence, QoL, and AF symptoms.
Results In 323 patients with 2 years of follow-up, 72% achieved AF elimination off antiarrhythmic drugs (AADs), 15% achieved AF control with AADs, and 13% had recurrent AF. The physical component summary scores of the Medical Outcomes Study Short Form 36 increased from 58.8 ± 20.1 to 76.2 ± 19.2 (p < 0.001) and the mental component summary scores of the Short Form 36 increased from 65.3 ± 18.6 to 79.8 ± 15.8 (p < 0.001). Post-ablation QoL improvements were noted across ablation outcomes, including recurrent AF (change in physical component summary: 12.1 ± 19.7 and change in mental component summary: 9.7 ± 17.9), with no significant differences in QoL improvement across 3 ablative efficacy outcomes. However, in 103 patients who completed additional assessment with Mayo AF Symptom Inventories (on a scale of 0 to 48), those with AF elimination off AADs had a change in AF symptom frequency score of −9.5 ± 6.3, which was significantly higher than those with AF controlled with AADs (−5.6 ± 3.8, p = 0.03) or those with recurrent AF (−3.4 ± 8.4, p = 0.02). Independent predictors of limited QoL improvement included higher baseline QoL, obesity, and warfarin use at follow-up.
Conclusions AF ablation produces sustained QoL improvement at 2 years in patients with and without recurrence. AF-specific symptom assessment more accurately reflects ablative efficacy.

Introduction

Atrial fibrillation (AF) affects >6.7 million people in the U.S. and Europe.^[1,2] People with AF have impaired quality of life (QoL) compared with the general population.^[3,4] Thus, the impetus to eliminate AF has been great. Maintenance of sinus rhythm with antiarrhythmic drugs (AADs), however, has not been shown to have consistent superior benefits in QoL, major physical end points, stroke, or survival over rate-control strategies.^[4−6]

Primary curative AF ablation, with the potential for greater efficacy and freedom from the adverse side effects of AADs, is a viable option for select symptomatic patients.^[7,8] Post-ablation QoL improvement and/or a superior QoL benefit from ablation over pharmacologic rhythm control have been demonstrated in studies with limited sample sizes and follow-up durations ≤1 year.^[9−14] Nevertheless, establishing that QoL benefit lasts beyond 1 year and is attributable to ablation-specific effects would justify the broader application of this expensive procedure with uncommon, but significant risks.

The purpose of this prospective observational study was to establish the impact of AF ablation on QoL in symptomatic patients and to identify the relative contributions of patient-related factors, rhythm status, AAD use, and relief of AF-specific symptom burden.