Catheter Ablation of Asymptomatic Longstanding Persistent Atrial Fibrillation: Impact on Quality of Life, Exercise Performance, Arrhythmia Perception, and Arrhythmia‐Free Survival

Mohanty, Sanghamitra; Mohanty, Prasant; Biase, Luigi Di; Holcomb, Shawna; Trivedi, Chintan; Bai, Rong; Burkhardt, David; Hongo, Richard; Sheng, Hao; Beheiry, Salwa; Santoro, Francesco; Forleo, Giovanni B.; Gallinghouse, Joseph G.; Horton, Rodney; Sánchez, Javier; Bailey, Shane; Hranitzky, Patrick; Zagrodzky, Jason

doi:10.1111/jce.12467

Cited by 74 publications

(68 citation statements)

References 32 publications

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“…The pathophysiology underlying HF and AF resulting in compromised stroke volume is the likely basis of altered exercise tolerance. [15][16][17][18]30 Thus, the significant improvement in 6MWD could reflect betterment in cardiac contractility and rhythm resulting in restoration of a more efficient cardiac contraction following successful ablation. Our results further corroborated the correlation between ablation success and improvement in QoL.…”

Section: -29mentioning

confidence: 99%

Ablation Versus Amiodarone for Treatment of Persistent Atrial Fibrillation in Patients With Congestive Heart Failure and an Implanted Device

et al. 2016

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T ranscatheter ablation represents a valid treatment option in patients with drug-refractory symptomatic atrial fibrillation (AF). 1 The majority of catheter ablation trials have mainly enrolled patients with preserved left ventricular (LV) systolic function. In these patients, the ablative treatment has been shown to be effective in reducing morbidity, 2-4 improving the quality of life (QoL), [3][4][5][6] and improving functional capacity. 5-7Background-Whether catheter ablation (CA) is superior to amiodarone (AMIO) for the treatment of persistent atrial fibrillation (AF) in patients with heart failure is unknown. Methods and Results-Thiswas an open-label, randomized, parallel-group, multicenter study. Patients with persistent AF, dualchamber implantable cardioverter defibrillator or cardiac resynchronization therapy defibrillator, New York Heart Association II to III, and left ventricular ejection fraction <40% within the past 6 months were randomly assigned (1:1 ratio) to undergo CA for AF (group 1, n=102) or receive AMIO (group 2, n=101). Recurrence of AF was the primary end point. All-cause mortality and unplanned hospitalization were the secondary end points. Patients were followed up for a minimum of 24 months. At the end of follow-up, 71 (70%; 95% confidence interval, 60%-78%) patients in group 1 were recurrence free after an average of 1.4±0.6 procedures in comparison with 34 (34%; 95% confidence interval, 25%-44%) in group 2 (log-rank P<0.001). The success rate of CA in the different centers after a single procedure ranged from 29% to 61%. After adjusting for covariates in the multivariable model, AMIO therapy was found to be significantly more likely to fail (hazard ratio, 2.5; 95% confidence interval, 1.5-4.3; P<0.001) than CA. Over the 2-year follow-up, the unplanned hospitalization rate was (32 [31%] in group 1 and 58 [57%] in group 2; P<0.001), showing 45% relative risk reduction (relative risk, 0.55; 95% confidence interval, 0.39-0.76). A significantly lower mortality was observed in CA (8 [8%] versus AMIO (18 [18%]; P=0.037). Conclusions-This multicenter randomized study shows that CA of AF is superior to AMIO in achieving freedom from AF at long-term follow-up and reducing unplanned hospitalization and mortality in patients with heart failure and persistent AF. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00729911. However, a significant number of patients with AF also have LV systolic dysfunction. AF and heart failure (HF) frequently coexist and are often associated with several common predisposing risk factors such as hypertension, coronary artery disease, structural heart disease (nonischemic, valvular), diabetes mellitus, obesity, and obstructive sleep apnea . 8,9 Importantly, the prevalence of AF increases with HF severity, ranging from 5% in functional class I patients to ≈50% in class IV patients.Also, the prevalence of HF in patients with AF has been estimated at 42%. 8 The combination of HF and AF leads to deleterious hemodynamic and symp...

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Section: -29mentioning

confidence: 99%

Ablation Versus Amiodarone for Treatment of Persistent Atrial Fibrillation in Patients With Congestive Heart Failure and an Implanted Device

et al. 2016

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“…Mohanty et al 6 found that successful ablation improved the exercise performance and quality of life in 61 asymptomatic patients with longstanding persistent AF. However, 25 patients experienced AF recurrence and 21 (84%) were symptomatic.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4] Up until now, data on catheter ablation for patients with asymptomatic AF are limited. 5,6 Whether patients with asymptomatic AF could benefit from ablation remains unclear. In the present study, we investigated the Lingmin Wu and Yanlai Lu contributed equally to this work.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Radiofrequency Catheter Ablation Between Asymptomatic and Symptomatic Persistent Atrial Fibrillation: A Propensity Score Matched Analysis

Zheng

et al. 2016

Cardiovasc electrophysiol

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and ‡Duke-NUS Graduate Medical School, Singapore RFCA for Asymptomatic Persistent AF. Background: Whether patients with asymptomatic atrial fibrillation (AF) could benefit from radiofrequency catheter ablation (RFCA) remains unclear. This study aimed to compare the outcomes of RFCA between asymptomatic and symptomatic AF.Methods: Sixty-six patients with asymptomatic persistent AF who underwent the primary ablation for AF were enrolled; 132 patients with symptomatic persistent AF were matched using propensity score matching. All patients underwent circumferential pulmonary vein isolation in combination with linear ablation using AF termination as the primary procedural endpoint.Results: Sinus rhythm (SR) was restored by ablation in 18 (27.3%) patients in the asymptomatic group and 93 (70.5%) in the symptomatic group (P < 0.001). Combined with intravenous infusion of ibutilide (1 mg), the numbers were 45 (68.2%) and 116 (87.8%), respectively (P = 0.001). At 1-year follow-up, SR was present in 23 (34.8%) patients in the asymptomatic group and 78 (59.1%) in the symptomatic group without any antiarrhythmic medication after a single procedure (P = 0.001). Of the 43 patients experiencing recurrence in the asymptomatic group, 16 (37.2%) had recurrent atrial tachycardia (AT)-related symptoms. Multivariate analysis showed that asymptomatic AF was independently associated with AF failed to be terminated by ablation (OR: 7.1; 95% CI: 3.4 to 14.9; P < 0.001) and recurrence (OR: 2.2; 95% CI: 1.1 to 4.4; P = 0.018). Patients with asymptomatic AF showed less improvement in quality of life postablation than those with symptoms.Conclusion: Current catheter ablation techniques showed worse outcomes in asymptomatic AF patients than in those with symptoms. Recurrent AT could cause significant symptoms in previously asymptomatic

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“…There is a growing interest in the impact of AF on the health-related quality of life (HRQoL), which has been considered as an important patient-centered health outcome measurement (Mohanty et al 2014). However, the results of previous studies have been conflicting.…”

Section: Introductionmentioning

confidence: 99%

“…There were also studies with results suggesting that the HRQoL in AF patients might initially decrease, but improve progressively in the next few months or years (Jenkins et al 2005;Reynolds et al 2006). Mohanty et al (2014) has also found that even in patients with asymptomatic longstanding persistent AF, successful ablation could still improve HRQoL. Several types of weakness in methodology have been proposed as contributors to such conflicting results (Thrall et al 2006;Aliot et al 2014).…”

Section: Introductionmentioning

confidence: 99%

Different Impacts of Atrial Fibrillation and Cardiac Premature Contractions on the Health-Related Quality of Life in Elderly People: The Yilan Study

Hsu

Tsao

Chen

et al. 2016

Tohoku J. Exp. Med.

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Atrial fibrillation (AF) is currently recognized as one of the most common cardiac arrhythmias worldwide, with the increasing prevalence that has been estimated to be as high as 9% among the elderly. Healthrelated quality of life (HRQoL) has become an important patient-centered health outcome measurement, but the impacts created by AF and other arrhythmias with similar symptoms, such as frequent atrial and ventricular premature contractions (APCs and VPCs, defined as ≥ 3 beats/5 minutes), have not been extensively evaluated. The Yilan Study is a population-based community health survey, which in part aims to evaluate the prevalence and impacts of these arrhythmias on the HRQoL in a community dwelling elderly population. A total of 1,732 citizens from the Yilan, Taiwan, aged 65 years or older (45.8% male) were enrolled and visited at their homes, where HRQoL was measured utilizing the Short Form-12 Health Survey. Each participant's heart rhythm was recorded with an electrocardiographic monitor for 5 minutes. The results disclosed that the prevalence of AF of this aged population was 5.8%, similar to the mean global prevalence. Besides, the prevalence of frequent APCs and frequent VPCs in these elderly people were 7.1% and 5.5%, respectively. After multiple regression analysis, elderly people with AF had lower scores in the physical component of HRQoL, while those elderly people with frequent VPCs had lower scores in the mental component. Ultimately, these findings can provide additional useful and populationspecific information about AF, and assist medical professionals in designing more effective strategies for cardiac arrhythmia treatments.

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Catheter Ablation of Asymptomatic Longstanding Persistent Atrial Fibrillation: Impact on Quality of Life, Exercise Performance, Arrhythmia Perception, and Arrhythmia‐Free Survival

Abstract: Successful ablation improves exercise performance and QoL in asymptomatic LSP-AF patients.

Cited by 74 publications

References 32 publications

Ablation Versus Amiodarone for Treatment of Persistent Atrial Fibrillation in Patients With Congestive Heart Failure and an Implanted Device

Ablation Versus Amiodarone for Treatment of Persistent Atrial Fibrillation in Patients With Congestive Heart Failure and an Implanted Device

Comparison of Radiofrequency Catheter Ablation Between Asymptomatic and Symptomatic Persistent Atrial Fibrillation: A Propensity Score Matched Analysis

Different Impacts of Atrial Fibrillation and Cardiac Premature Contractions on the Health-Related Quality of Life in Elderly People: The Yilan Study

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