Patient-reported quality of life after stand-alone and concomitant arrhythmia surgery: a systematic review and meta-analysis

Abstract

OBJECTIVES Patient-reported quality of life (QOL) has become an important endpoint for arrhythmia surgery for atrial fibrillation (AF). While studies specifically evaluating the effect of arrhythmia surgery on QOL are scarce, we aimed to summarize current evidence of QOL following concomitant and stand-alone arrhythmia surgery for AF. METHODS All studies reporting on QOL using questionnaires from patients undergoing arrhythmia surgery for AF, both stand-alone and concomitant, were included in this systematic review. A meta-analysis was performed on inter-study heterogeneity of changes in QOL on 9 of 12 included studies that used the Short-Form 36 tool and meta-regression based on rhythm outcome after 1 year was executed. Finally, differences in QOL following stand-alone arrhythmia surgery and concomitant procedures were evaluated. RESULTS Overall, QOL scores improved 1 year after surgical ablation for AF evaluated by several questionnaires. In stand-alone arrhythmia procedures, meta-regression showed significant improvements in those who were in sinus rhythm compared to those in AF after 1 year. This association between an improved QOL and the procedural effectiveness was also suggested in concomitant procedures. However, when comparing QOL of patients undergoing cardiac surgery with and without add-on surgical ablation for AF, only the variable ‘physical role’ demonstrated a significant improvement. CONCLUSIONS In patients with AF, QOL improves after both stand-alone and concomitant arrhythmia surgery. In the concomitant group, this improvement can be attributed to both the cardiac procedure itself as well as the add-on arrhythmia surgery. However, both in stand-alone and concomitant procedures, the improvement in QOL seems to be related to the effectiveness of the procedure to maintain sinus rhythm after 12 months.

Unilateral left-sided thoracoscopic ablation of atrial fibrillation concomitant to minimally invasive bypass grafting of the left anterior descending artery

“…Mean postoperative LAEF was 38% [ 7 ]. Of those 13 patients, 11 (3 persAF, 8 pAF) patients also had a preoperative TTE in SR. After analysis of pre- and postoperative TTE in those 11 patients, mean LAEF increased (26% [ 11 ] to 38% [ 7 ], P = 0.01, see Fig. 3 ).…”

Hybrid ablation of atrial fibrillation: A unilateral left‐sided thoracoscopic approach

“… 27 Therefore, unilateral left‐sided thoracoscopic HA may not only reduce major complications compared to a bilateral approach but also to percutaneous approaches on the long term. Furthermore, as surgical ablation for AF improves the quality of life (QOL), especially in patients where SR is established, 28 QOL may even further improve when complications and postoperative pain are reduced by limiting surgery to one side only.…”

“…Furthermore, as surgical ablation for AF improves the quality of life (QOL), especially in patients where SR is established, 28 QOL may even further improve when complications and postoperative pain are reduced by limiting surgery to one side only.…”

Concomitant arrhythmia surgery should be a standard procedure in AF patients undergoing cardiac surgery

“…A recent systematic review and meta-analysis by our group illustrated that arrhythmia surgery for AF does improve QOL after both stand-alone and concomitant arrhythmia surgery. 11 Obviously, for patients undergoing cardiac surgery and add-on AF surgery, the improvement in QOL can be attributed to the cardiac surgery itself as well as the additional arrhythmia surgery. However, in both groups, the gain in QOL was related to the surgical efficacy outcome (e.g., sinus rhythm after 12 months).…”

“…A potential explanation is the lack of strong data on improvement in quality of life (QOL) when performing add‐on arrhythmia surgery. A recent systematic review and meta‐analysis by our group illustrated that arrhythmia surgery for AF does improve QOL after both stand‐alone and concomitant arrhythmia surgery 11 . Obviously, for patients undergoing cardiac surgery and add‐on AF surgery, the improvement in QOL can be attributed to the cardiac surgery itself as well as the additional arrhythmia surgery.…”