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

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.