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.
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