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Quality of Life and Outcome of Atrial Fibrillation Ablation
Quick Takes
- In the secondary analysis of STAR AF II randomized clinical trial, catheter ablation was associated with a significant decrease in atrial fibrillation (AF) burden and increase in quality of life (QOL) at 18 months.
- Patients with <70% reduction in AF burden had a significantly lower QOL score compared with those with >70% reduction in AF burden.
Study Questions:
Is ablation for atrial fibrillation (AF) associated with changes in quality of life (QOL) in patients with persistent AF?
Methods:
This study was a secondary analysis of STAR AF II (Substrate and Trigger Ablation for Reduction of Atrial Fibrillation–Part II), which was a prospective randomized trial comparing three strategies for ablation of persistent AF: 1) pulmonary vein isolation (PVI), 2) PVI plus complex fractionated electrograms, or 3) PVI plus linear lesions. QOL was assessed at baseline and at 6, 12, and 18 months after ablation. Scores were also converted to a physical health component score (PCS) and a mental health component score (MCS).
Results:
Among the 549 patients, QOL was assessed in 466 (85%) patients. Mean age was 60 years; 434 (79%) individuals were men. The AF burden significantly decreased from a mean of 82% before ablation to 6.6% after ablation. There were significant improvements in mean PCS (68.3 to 82.5) and MCS (35.3 to 37.5). Significant QOL improvement occurred in all three study arms and regardless of AF recurrence. In patients with <70% reduction in AF burden, the increase in PCS was significantly less than in those with >70% reduction, and only three of eight subscales showed significant improvement.
Conclusions:
The authors concluded that the decreases in AF burden after ablation were significantly associated with improvements in QOL. QOL changes were significantly associated with the percentage of AF burden reduction after ablation.
Perspective:
Improvement in symptomatic relief is the primary indication for AF ablation. This study shows that improvement in QOL is tightly associated with freedom from AF following ablation. Freedom from AF has been defined across many studies as the absence of AF lasting more than 30 seconds, clearly not a very relevant cutoff from the QOL assessment. While placebo effect could affect QOL in patients undergoing an invasive procedure, it is unlikely given that the QOL assessments continued to show improvement 18 months following the ablation.
Clinical Topics: Arrhythmias and Clinical EP, Cardiovascular Care Team, Prevention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias
Keywords: Arrhythmias, Cardiac, Atrial Fibrillation, Catheter Ablation, Electrophysiologic Techniques, Cardiac, Mental Health, Pulmonary Veins, Quality of Life, Secondary Prevention
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