Long-Term Quality of Life After Ablation of Atrial Fibrillation. The Impact of Recurrence, Symptom Relief, and Placebo Effect

Anita Wokhlu, Kristi H. Monahan, David O. Hodge, Samuel J Asirvatham, Paul Andrew Friedman, Thomas M. Munger, David John Bradley, Christine M. Bluhm, Janis M. Haroldson, Douglas L Packer

Research output: Contribution to journalArticle

138 Citations (Scopus)

Abstract

Objectives: We sought to determine the relationship between atrial fibrillation (AF) ablation efficacy, quality of life (QoL), and AF-specific symptoms at 2 years. Background: Although the primary goal of AF ablation is QoL improvement, this effect has yet to be demonstrated in the long term. Methods: A total of 502 symptomatic AF ablation recipients were prospectively followed for recurrence, QoL, and AF symptoms. Results: In 323 patients with 2 years of follow-up, 72% achieved AF elimination off antiarrhythmic drugs (AADs), 15% achieved AF control with AADs, and 13% had recurrent AF. The physical component summary scores of the Medical Outcomes Study Short Form 36 increased from 58.8 ± 20.1 to 76.2 ± 19.2 (p < 0.001) and the mental component summary scores of the Short Form 36 increased from 65.3 ± 18.6 to 79.8 ± 15.8 (p < 0.001). Post-ablation QoL improvements were noted across ablation outcomes, including recurrent AF (change in physical component summary: 12.1 ± 19.7 and change in mental component summary: 9.7 ± 17.9), with no significant differences in QoL improvement across 3 ablative efficacy outcomes. However, in 103 patients who completed additional assessment with Mayo AF Symptom Inventories (on a scale of 0 to 48), those with AF elimination off AADs had a change in AF symptom frequency score of -9.5 ± 6.3, which was significantly higher than those with AF controlled with AADs (-5.6 ± 3.8, p = 0.03) or those with recurrent AF (-3.4 ± 8.4, p = 0.02). Independent predictors of limited QoL improvement included higher baseline QoL, obesity, and warfarin use at follow-up. Conclusions: AF ablation produces sustained QoL improvement at 2 years in patients with and without recurrence. AF-specific symptom assessment more accurately reflects ablative efficacy.

Original languageEnglish (US)
Pages (from-to)2308-2316
Number of pages9
JournalJournal of the American College of Cardiology
Volume55
Issue number21
DOIs
StatePublished - May 25 2010

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Placebo Effect
Atrial Fibrillation
Quality of Life
Recurrence
Quality Improvement
Anti-Arrhythmia Agents
Symptom Assessment
Warfarin

Keywords

  • ablation
  • anticoagulants
  • atrium
  • fibrillation
  • obesity
  • quality of life

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Long-Term Quality of Life After Ablation of Atrial Fibrillation. The Impact of Recurrence, Symptom Relief, and Placebo Effect. / Wokhlu, Anita; Monahan, Kristi H.; Hodge, David O.; Asirvatham, Samuel J; Friedman, Paul Andrew; Munger, Thomas M.; Bradley, David John; Bluhm, Christine M.; Haroldson, Janis M.; Packer, Douglas L.

In: Journal of the American College of Cardiology, Vol. 55, No. 21, 25.05.2010, p. 2308-2316.

Research output: Contribution to journalArticle

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AU - Wokhlu, Anita

AU - Monahan, Kristi H.

AU - Hodge, David O.

AU - Asirvatham, Samuel J

AU - Friedman, Paul Andrew

AU - Munger, Thomas M.

AU - Bradley, David John

AU - Bluhm, Christine M.

AU - Haroldson, Janis M.

AU - Packer, Douglas L

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N2 - Objectives: We sought to determine the relationship between atrial fibrillation (AF) ablation efficacy, quality of life (QoL), and AF-specific symptoms at 2 years. Background: Although the primary goal of AF ablation is QoL improvement, this effect has yet to be demonstrated in the long term. Methods: A total of 502 symptomatic AF ablation recipients were prospectively followed for recurrence, QoL, and AF symptoms. Results: In 323 patients with 2 years of follow-up, 72% achieved AF elimination off antiarrhythmic drugs (AADs), 15% achieved AF control with AADs, and 13% had recurrent AF. The physical component summary scores of the Medical Outcomes Study Short Form 36 increased from 58.8 ± 20.1 to 76.2 ± 19.2 (p < 0.001) and the mental component summary scores of the Short Form 36 increased from 65.3 ± 18.6 to 79.8 ± 15.8 (p < 0.001). Post-ablation QoL improvements were noted across ablation outcomes, including recurrent AF (change in physical component summary: 12.1 ± 19.7 and change in mental component summary: 9.7 ± 17.9), with no significant differences in QoL improvement across 3 ablative efficacy outcomes. However, in 103 patients who completed additional assessment with Mayo AF Symptom Inventories (on a scale of 0 to 48), those with AF elimination off AADs had a change in AF symptom frequency score of -9.5 ± 6.3, which was significantly higher than those with AF controlled with AADs (-5.6 ± 3.8, p = 0.03) or those with recurrent AF (-3.4 ± 8.4, p = 0.02). Independent predictors of limited QoL improvement included higher baseline QoL, obesity, and warfarin use at follow-up. Conclusions: AF ablation produces sustained QoL improvement at 2 years in patients with and without recurrence. AF-specific symptom assessment more accurately reflects ablative efficacy.

AB - Objectives: We sought to determine the relationship between atrial fibrillation (AF) ablation efficacy, quality of life (QoL), and AF-specific symptoms at 2 years. Background: Although the primary goal of AF ablation is QoL improvement, this effect has yet to be demonstrated in the long term. Methods: A total of 502 symptomatic AF ablation recipients were prospectively followed for recurrence, QoL, and AF symptoms. Results: In 323 patients with 2 years of follow-up, 72% achieved AF elimination off antiarrhythmic drugs (AADs), 15% achieved AF control with AADs, and 13% had recurrent AF. The physical component summary scores of the Medical Outcomes Study Short Form 36 increased from 58.8 ± 20.1 to 76.2 ± 19.2 (p < 0.001) and the mental component summary scores of the Short Form 36 increased from 65.3 ± 18.6 to 79.8 ± 15.8 (p < 0.001). Post-ablation QoL improvements were noted across ablation outcomes, including recurrent AF (change in physical component summary: 12.1 ± 19.7 and change in mental component summary: 9.7 ± 17.9), with no significant differences in QoL improvement across 3 ablative efficacy outcomes. However, in 103 patients who completed additional assessment with Mayo AF Symptom Inventories (on a scale of 0 to 48), those with AF elimination off AADs had a change in AF symptom frequency score of -9.5 ± 6.3, which was significantly higher than those with AF controlled with AADs (-5.6 ± 3.8, p = 0.03) or those with recurrent AF (-3.4 ± 8.4, p = 0.02). Independent predictors of limited QoL improvement included higher baseline QoL, obesity, and warfarin use at follow-up. Conclusions: AF ablation produces sustained QoL improvement at 2 years in patients with and without recurrence. AF-specific symptom assessment more accurately reflects ablative efficacy.

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KW - anticoagulants

KW - atrium

KW - fibrillation

KW - obesity

KW - quality of life

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