This pilot study demonstrates the effectiveness and safety of maze III surgery for lone PAF. In patients without sick-sinus syndrome, this intervention offers a sensible alternative to His bundle ablation and lifelong pacemaker dependency.
Before being introduced for widespread use, health status instruments should be evaluated for reliability, validity, and responsiveness to relevant clinical changes. In a previous study the validity and reliability of Aquarel, a disease-specific quality-of-life (QOL) questionnaire for pacemaker patients, were tested and found satisfactory. The purpose of this study was to assess the sensitivity to change in health of Aquarel. A cohort of 51 patients was assessed at baseline and at 4-6 weeks after pacemaker implantation. We compared the sensitivity to change over time on the Aquarel scores to the scores on the SF-36 using various techniques (t-test value, effect size, standard error of measurement). Using the 1-standard error of measurement (SEM) criterion for clinically relevant change, Aquarel seemed to provide better classification of patients compared to the SF-36 alone. This study supports the value of Aquarel as a disease-specific measure of QOL in pacemaker patients.
Current clinical practice permits the use of single chamber ventricular or dual chamber pacemakers. However, it is not known which type of pacemaker results in superior clinical and patient outcomes. This is of growing importance because of the higher costs and increased risk of technical failures of dual chamber pacemakers. Patient outcomes can be assessed with quality of life questionnaires, but it is unclear which questionnaires are valid for use in pacemaker patients. This article reappraises studies on quality of life instruments for pacemaker patients. We searched MEDLINE (1985-1998) for studies assessing quality-of-life in general and in pacemaker patients. The SF-36 appeared to be the best among generic questionnaires because of its psychometric characteristics and experience of use. Concerning disease specific instruments, the Karolinska quality of life questionnaire has desirable content validity but lacks more rigorous psychometric validation, which constitutes a serious limitation. Previous studies suggested that implantation of atrioventricular pacemakers improves quality-of-life compared to ventricular pacemakers, but since no well-designed and validated questionnaire exists, these results should be interpreted with caution. The best outcome measure to evaluate quality-of-life in pacemaker patients would be a combination of a generic health profile with established reliability and validity supplemented with a cardiovascular assessment adjusted to suit pacemaker patients. By doing so, individual scores can be compared within a disease cohort and to same-aged, nondiseased persons, as well as other diseased populations. The development and validation of such an instrument is currently needed.
Pacemaker implantation strongly improves QoL, but neither single- nor dual- sensor-driven pacing offered additional improvement in QoL during the initial 8 months after the first PM implant.
With the tremendous advances in cardiac pacing during the past four decades, cardiac pacemaker implantation is now a common clinical procedure. In recent years, the indications for permanent pacemakers have expanded. This increase in reasons for pacing and shift in mode of pacing have been caused by the evolution of pacemaker therapy from a life-saving measure (mortality), to one aimed at improving healthrelated quality of life (HRQoL). Until now the efficacy of pacing therapy has predominantly been measured using bobjectiveQ criteria. However, in recent years the importance of HRQoL as an outcome measure has increasingly been recognized as patients prefer quality over quantity of life.In this review we describe the development and testing of Aquarel, a new developed HRQoL questionnaire for pacemaker patients, composed of a generic core module with disease specific add-ons. Current and future research to improve the Aquarel questionnaire is also described. D 2005 Elsevier Ireland Ltd. All rights reserved.Keywords: Cardiac pacing; Quality of life; Aquarel In the Netherlands there is an increased implantation rate of cardiac pacemakers in patients of all ages over the past decade (Fig. 1). This increase in the number of implanted pacemaker-units and leads combined with a rising population age contribute to an increase in hospitalisation, care and follow-up. Until now the efficacy of pacing therapy has predominantly been measured using clinical outcomes such as improvement of prognosis, relief of symptoms, complications, technical failures and recalls. However, to evaluate the full spectrum of outcome of pacemaker therapy patient reported outcomes as well as clinical outcomes should be measured. In recent years the importance of health-related quality of life (HRQoL) as an outcome measure has increasingly been recognized [1,2]. This has particular relevance in cardiac pacing because the goal of therapy for most patients with chronic disease is improvement in function, not cure [3]. These measures should be incorporated as one of the primary measures of outcome in the evaluation of new therapies in chronic diseases including cardiac pacing. Doing so, clinicians, patients, policymakers, health care providers and HRQoL researchers gain experience with these measures.To measure HRQoL, appropriate instruments should be used and a large number of questionnaires has been developed in the past two decades. However, in the field of cardiac pacing until recently several instruments were used to measure HRQoL that were not properly validated and applied [4][5][6][7][8][9][10][11][12][13][14][15][16][17]. Consequently these HRQoL data should be interpreted cautiously. HRQoL is typically measured either in a generic or a specific way. Generic means that an instrument gives information on several dimensions and is useful for a variety of illnesses, diseases and different (patient-) populations, allowing for comparison between these (patient-) populations. Disease specific questionnaires focus on dimensions most relevant ...
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