Effect of catheter ablation on quality of life in patients with atrial fibrillation and its correlation with arrhythmia outcome

Raine, Daniel; Langley, Philip; Shepherd, Ewen; Lord, Sue; Murray, Steven R.; Murray, Alan; Bourke, John

doi:10.1136/openhrt-2015-000302

Cited by 20 publications

(11 citation statements)

References 18 publications

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“…Generic instruments measure general health and functioning and are influenced by patient demographics and comorbidity, while AF‐specific questionnaires were developed specifically to measure AF‐related PROs. Our results suggest that the AF6 is more sensitive than SF‐36 in capturing more components of AF, which is in line with previous studies using other AF‐specific PRO instruments . The potential for comorbidities to impact PRO scores further points to the need for AF‐specific instruments when studying AF interventions.…”

Section: Discussionsupporting

confidence: 89%

“…Wokhlu et al used the not yet validated Mayo AF‐Specific Symptom Inventory and showed significant improvement in 10 of 12 symptoms 2 years after ablation . Raine et al used a validated AF‐specific instrument, the Atrial Fibrillation Effect on Quality‐of‐Life, before and 3 months after AF ablation and found a significant improvement only in patients without AF recurrence …”

Section: Discussionmentioning

confidence: 99%

“…We believe that rhythm monitoring is an important additional aspect in order to correctly understand the effects on PROs. Intermittent monitoring may have contributed to the conflicting results reported by these studies, with some reporting improvement in generic PROs regardless of AF recurrences and others improvement only in patients who are classified as free of AF recurrences . The recently published 5‐year follow‐up of MANTRA‐PAF (The Medical Antiarrhythmic Treatment or Radiofrequency Ablation in Paroxysmal Atrial Fibrillation) trial showed that the improvement in generic HRQoL measured by SF‐36 seen at 2 years after ablation remained and was similar in patients who underwent AF ablation and pharmacological rhythm control in spite of more AF recurrences in the latter group .…”

Section: Discussionmentioning

confidence: 99%

“…The recently published 5‐year follow‐up of MANTRA‐PAF (The Medical Antiarrhythmic Treatment or Radiofrequency Ablation in Paroxysmal Atrial Fibrillation) trial showed that the improvement in generic HRQoL measured by SF‐36 seen at 2 years after ablation remained and was similar in patients who underwent AF ablation and pharmacological rhythm control in spite of more AF recurrences in the latter group . However, previous studies that did include AF‐specific instruments (Mayo AF‐Specific Symptom Inventory, Atrial Fibrillation Effect on Quality‐of‐Life, and University of Toronto atrial fibrillation severity scale) showed that ablation outcome is most often correlated with AF‐specific PROs …”

Section: Discussionmentioning

confidence: 99%

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Patient‐Reported Outcomes in Relation to Continuously Monitored Rhythm Before and During 2 Years After Atrial Fibrillation Ablation Using a Disease‐Specific and a Generic Instrument

Björkenheim

Brandes

Magnuson

et al. 2018

JAHA

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BackgroundAtrial fibrillation (AF) ablation improves patient‐reported outcomes, irrespective of mode of intermittent rhythm monitoring. We evaluated the use of an AF‐specific and a generic patient‐reported outcomes instrument during continuous rhythm monitoring 2 years after AF ablation.Methods and ResultsFifty‐four patients completed the generic 36‐Item Short‐Form Health Survey and the AF‐specific AF6 questionnaires before and 6, 12, and 24 months after AF ablation. All patients underwent continuous ECG monitoring via an implantable loop recorder. The generic patient‐reported outcomes scores were compared with those of a Swedish age‐ and sex‐matched population. After ablation, both summary scores reached normative levels at 24 months, while role‐physical and vitality remained lower than norms. Responders to ablation (AF burden <0.5%) reached the norms in all individual 36‐Item Short‐Form Health Survey domains, while nonresponders (AF burden >0.5%) reached norms only in social functioning and mental component summary. All AF6 items and the sum score showed moderate to large improvement in both responders and nonresponders, although responders showed significantly greater improvement in all items except item 1 from before to 24 months after ablation. Higher AF burden was independently associated with poorer physical component summary and AF6 sum score.ConclusionsThe AF‐specific AF6 questionnaire was more sensitive to changes related to AF burden than the generic 36‐Item Short‐Form Health Survey. Patients improved as documented by both instruments, but a higher AF burden after ablation was associated with poorer AF‐specific patient‐reported outcomes and poorer generic physical but not mental health. Our results support the use of an AF‐specific instrument, alone or in combination with a generic instrument, to assess the effect of ablation.Clinical Trial RegistrationURL: https://www.clinicaltrials.gov. Unique identifier: NCT00697359.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Patient‐Reported Outcomes in Relation to Continuously Monitored Rhythm Before and During 2 Years After Atrial Fibrillation Ablation Using a Disease‐Specific and a Generic Instrument

Björkenheim

Brandes

Magnuson

et al. 2018

JAHA

View full text Add to dashboard Cite

show abstract

“…It has been shown that the QoL score returned to the pre-procedural level after only several weeks post ablation, staying at the initial level during a long-term follow-up [ 86 ]. The QoL improvement was strikingly higher in patients who were AF-free than in those with recurrent arrhythmia after the procedure [ 86 – 88 ]. However, even in patients with AF recurrence, a significant QoL improvement was observed following ablation compared to pre-ablation values, possibly because of the higher proportion of asymptomatic arrhythmia episodes, reduction in AF burden, LA denervation, increased AAD effectiveness or placebo effect post procedure [ 88 ].…”

Section: Catheter Ablation Proceduresmentioning

confidence: 99%

Catheter Ablation of Atrial Fibrillation: An Overview for Clinicians

et al. 2017

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Catheter ablation (CA) of atrial fibrillation (AF) is currently one of the most commonly performed electrophysiology procedures. Ablation of paroxysmal AF is based on the elimination of triggers by pulmonary vein isolation (PVI), while different strategies for additional AF substrate modification on top of PVI have been proposed for ablation of persistent AF. Nowadays, various technologies for AF ablation are available. The radiofrequency point-by-point ablation navigated by electro-anatomical mapping system and cryo-balloon technology are comparable in terms of the efficacy and safety of the PVI procedure. Long-term success of AF ablation including multiple procedures varies from 50 to 80%. Arrhythmia recurrences commonly occur, mostly due to PV reconnection. The recurrences are particularly common in patients with non-paroxysmal AF, dilated left atrium and the "early recurrence" of AF within the first 2–3 post-procedural months. In addition, this complex procedure can be accompanied by serious complications, such as cardiac tamponade, stroke, atrio-esophageal fistula and PV stenosis. Therefore, CA represents a second-line treatment option after a trial of antiarrhythmic drug(s). Good candidates for the procedure are relatively younger patients with symptomatic and frequent episodes of AF, with no significant structural heart disease and no significant left atrial enlargement. Randomized trials demonstrated the superiority of ablation compared to antiarrhythmic drugs in terms of improving the quality of life and symptoms in AF patients. However, nonrandomized studies reported additional clinical benefits from ablation over drug therapy in selected AF patients, such as the reduction of the mortality and stroke rates and the recovery of tachyarrhythmia-induced cardiomyopathy. Future research should enable the creation of more durable ablative lesions and the selection of the optimal lesion set in each patient according to the degree of atrial remodeling. This could provide better long-term CA success and expand indications for the procedure, especially among the patients with non-paroxysmal AF.

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