Improvement in Quality of Life After Catheter Ablation for Paroxysmal Versus Long‐standing Persistent Atrial Fibrillation: A Prospective Study With 3‐Year Follow‐up

Abstract

BackgroundChanges in quality of life (QoL) after catheter ablation for long‐standing persistent atrial fibrillation (LSPAF) are not well described. We sought to compare QoL improvement after catheter ablation of paroxysmal atrial fibrillation (PAF) versus that after LSPAF.Methods and ResultsA total of 261 PAF and 126 LSPAF ablation recipients were prospectively followed for arrhythmia recurrence, QoL, hospital stay, and sick leave. In PAF versus LSPAF groups, 1.3±0.6 versus 1.6±0.7 procedures were performed per patient (P<0.00001) during a 3‐year follow‐up. Good arrhythmia control was achieved in 86% versus 87% of patients (P=0.69) and in 69% versus 69% of patients not receiving antiarrhythmic drugs (P=0.99). The baseline QoL was better in the PAF than in the LSPAF group (European Quality of Life Group instrument self‐report questionnaire visual analog scale: 66.4±14.2 versus 61.0±14.2, P=0.0005; European Quality of Life Group 3‐level, 5‐dimensional descriptive system: 71.4±9.2 versus 67.7±13.8, P=0.002). Postablation 3‐year increase in QoL was significant in both groups (all P<0.00001) and significantly lower in PAF versus LSPAF patients (visual analog scale: +5.0±14.5 versus +10.2±12.8, P=0.001; descriptive system: +5.9±14.3 versus +9.3±13.9, P=0.03). In multivariate analysis, LSPAF, less advanced age, shorter history of AF and good arrhythmia control were consistently associated with postablation 3‐year improvement in QoL. Days of hospital stay for cardiovascular reasons and days on sick leave per patient/year were significantly reduced in both groups.ConclusionsPatients with LSPAF had worse baseline QoL. The magnitude of QoL improvement after ablation of LSPAF was significantly greater compared with after ablation of PAF, particularly when good arrhythmia control was achieved without the use of antiarrhythmic drugs.

Sinus rhythm restoration and arrhythmia noninducibility are major predictors of arrhythmia-free outcome after ablation for long-standing persistent atrial fibrillation: A prospective study

“…9 Our observation is in accordance with the results of studies in patients having all forms of persistent AF 2,4,6,18,[12][13][14][15][16][17][18][19][20][21][22] and confirms that the predictive value of restored SR at initial ablation extends beyond repeat procedures. 4,5,22 In patients with persistent AF, prior investigations of preprocedural factors identified smaller LA size, 2,22 shorter continuous AF duration, 1,2,4,8,21 younger age, 5,23 male gender, 4 absence of congestive heart failure, 4 absence of hypertension, 5 higher LAA outflow velocity, 15 LA systolic strain, and LAA wall velocity 22 as the predictors of arrhythmia-free outcome after the initial or repeat procedure(s). In our study, SR restoration at the initial procedure overpowered baseline clinical factors on multivariate analysis, which suggests that even an advanced arrhythmogenic substrate can be abolished by extensive ablation.…”

“…In addition, the extent of atrial ablation, which is often required to terminate persistent AF, has been repeatedly questioned, although recent studies (including reports from this population) showed that benefits from restored SR in terms of hemodynamic, functional, and quality-of life-improvement outweigh possible deleterious effects of extensive persistent AF/LSPAF ablation. 10,[13][14][15] The major findings of this study are as follows. (1) Nonrestoration of SR by ablation at the initial procedure is the dominant factor associated not only with clinical failure of the primary procedure but also with AF/AT recurrence after subsequent repeat procedure(s).…”

Healthcare Utilization and Quality of Life Improvement after Ablation for Paroxysmal AF in Younger and Older Patients

“…Bulkova et al. reported a decrease in the hospital admission rate from 48% before index ablation to 25%, 17%, and 8% in the subsequent 3 years in patients with paroxysmal AF . Both all‐cause and AF‐related readmission rates were lower in the SFAF study than in a published study reporting on utilization after ablations that occurred between 2005 and 2008 using the California State Inpatient Database …”

Attitudes toward Catheter Ablation for Atrial Fibrillation: A Nationwide Survey among Danish Cardiologists

“…1 QoL can be markedly reduced in patients with AF, and there is solid evidence that catheter ablation treatment can significantly improve the QoL not only in patients with PAF but also in patients with longstanding persistent AF. 4,6,15,16 Our study shows that Danish cardiologists are aware of the potential beneficial impact of ablation on patients' QoL, as more than 62% of the cardiologists expected improvement in QoL in more than 60% of the patients treated with ablation.…”