Long-Term Quality of Life After Ablation of Atrial Fibrillation

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

doi:10.1016/j.jacc.2010.01.040

Cited by 206 publications

(82 citation statements)

References 22 publications

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“…Therefore, assessment of freedom from AF postablation cannot be based on freedom from symptoms alone. 63 …”

Section: Section 2: Definitions Mechanisms and Rationale For Af Ablmentioning

confidence: 99%

“…Multiple studies have examined the effect of ablation on EF. 63,76,233,234,235,236 In a meta-analysis of nine studies of AF ablation in patients with HF, mean EF improved 11% (95% confidence interval [CI] 6.9–15.3, P <.001). 237 The effect of ablation on the future risk of stroke is of great interest, partly because of the morbidity and mortality associated with stroke, but also because of the need to inform decisions regarding continuing anticoagulation in patients with apparently successful ablations.…”

Section: Section 2: Definitions Mechanisms and Rationale For Af Ablmentioning

confidence: 99%

“…Multiple studies have demonstrated that asymptomatic AF commonly occurs in patients following catheter ablation. 56,57,63,413,442,936,937,938 Detection of these asymptomatic episodes of AF impact the characterization of the procedure as “successful.” Arrhythmia monitoring is an essential component of clinical trials aimed at assessing the outcomes of catheter ablation procedures and should be incorporated into all clinical trials designed to assess the efficacy of AF catheter ablation tools and techniques. The suggested monitoring strategies and minimum standards to be used as part of clinical trials are discussed in Section 13: Clinical Trial Design.…”

Section: Section 8: Follow-up Considerationsmentioning

confidence: 99%

“…57,414, 937,938,939,940,941,942,943,944 The proportion of asymptomatic compared with symptomatic events might be higher after AF ablation; two studies reported that the proportion of AF events that were asymptomatic was 11%–35% prior to and 53%–65% after ablation. 63,945,946 Another study reported that for patients in sinus rhythm, 53.8% of AF episodes were asymptomatic, with an increase in asymptomatic episodes changing from the acute to the chronic period after ablation, demonstrating that AF success cannot be based on the absence of symptoms alone. 936 …”

Section: Section 8: Follow-up Considerationsmentioning

confidence: 99%

“…63,270,536,1022,1023,1024 A recent meta-analysis analyzed 19 studies including 6167 patients, describing outcomes ≥3 years after AF ablation with a mean follow-up ≥24 months after the index procedure. Single procedure and multiple procedure freedom from atrial arrhythmias has been reported to be 53% and 80%, respectively, with substantial heterogeneity noted for single-procedure outcomes.…”

Section: Early Reablationmentioning

confidence: 99%

See 4 more Smart Citations

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

Calkins,

Kuck,

Cappato

et al. 2012

Heart Rhythm

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“…Therefore, assessment of freedom from AF postablation cannot be based on freedom from symptoms alone. 63 …”

Section: Section 2: Definitions Mechanisms and Rationale For Af Ablmentioning

confidence: 99%

Section: Section 2: Definitions Mechanisms and Rationale For Af Ablmentioning

confidence: 99%

Section: Section 8: Follow-up Considerationsmentioning

confidence: 99%

Section: Section 8: Follow-up Considerationsmentioning

confidence: 99%

Section: Early Reablationmentioning

confidence: 99%

See 3 more Smart Citations

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

Calkins,

Kuck,

Cappato

et al. 2012

Heart Rhythm

Self Cite

1,769

1,468

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Effect of Catheter Ablation vs Medical Therapy on Quality of Life Among Patients With Atrial Fibrillation

Mark

Anstrom

Sheng

et al. 2019

JAMA

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494

329

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IMPORTANCE Catheter ablation is more effective than drug therapy in restoring sinus rhythm in patients with atrial fibrillation (AF), but its incremental effect on long-term quality of life (QOL) is uncertain. OBJECTIVE To determine whether catheter ablation is more beneficial than conventional drug therapy for improving QOL in patients with AF. DESIGN, SETTING, AND PARTICIPANTS An open-label randomized clinical trial of catheter ablation vs drug therapy in 2204 symptomatic patients with AF older than 65 years or 65 years or younger with at least 1 risk factor for stroke. Patients were enrolled from November 2009 to April 2016 from 126 centers in 10 countries. Follow-up ended in December 2017. INTERVENTIONS Pulmonary vein isolation, with additional ablation procedures at the discretion of the investigators, for the catheter ablation group (n = 1108) and standard rhythm and/or rate-control drugs selected and managed by investigators for the drug therapy group (n = 1096). MAIN OUTCOMES AND MEASURES Prespecified co-primary QOL end points at 12 months, including the Atrial Fibrillation Effect on Quality of Life (AFEQT) summary score (range, 0-100; 0 indicates complete disability and 100 indicates no disability; patient-level clinically important difference, Ն5 points) and the Mayo AF-Specific Symptom Inventory (MAFSI) frequency score (range, 0-40; 0 indicates no symptoms and 40 indicates the most severe symptoms; patient-level clinically important difference, Յ−1.6 points) and severity score (range, 0-30; 0 indicates no symptoms and 30 indicates the most severe symptoms; patient-level clinically important difference, Յ−1.3 points). RESULTS Among 2204 randomized patients (median age, 68 years; 1385 patients [63%] were men, 946 [43%] had paroxysmal AF, and 1256 [57%] had persistent AF), the median follow-up was 48.5 months, and 1968 (89%) completed the trial. The mean AFEQT summary score was more favorable in the catheter ablation group than the drug therapy group at 12 months (86.4 points vs 80.9 points) (adjusted difference, 5.3 points [95% CI, 3.7-6.9]; P < .001). The mean MAFSI frequency score was more favorable for the catheter ablation group than the drug therapy group at 12 months (6.4 points vs 8.1 points) (adjusted difference, −1.7 points [95% CI, −2.3 to −1.2]; P < .001) and the mean MAFSI severity score was more favorable for the catheter ablation group than the drug therapy group at 12 months (5.0 points vs 6.5 points) (adjusted difference, −1.5 points [95% CI, −2.0 to −1.1]; P < .001). CONCLUSIONS AND RELEVANCE Among patients with symptomatic atrial fibrillation, catheter ablation, compared with medical therapy, led to clinically important and significant improvements in quality of life at 12 months. These findings can help guide decisions regarding management of atrial fibrillation.

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Discerning the Incidence of Symptomatic and Asymptomatic Episodes of Atrial Fibrillation Before and After Catheter Ablation (DISCERN AF)

Verma

Champagne²,

Sapp³

et al. 2013

JAMA Intern Med

284

185

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Background: The DISCERN AF study (Discerning Symptomatic and Asymptomatic Episodes Pre and Post Radiofrequency Ablation of Atrial Fibrillation) monitored atrial fibrillation (AF) using an implantable cardiac monitor (ICM) to assess the incidence and predictors of asymptomatic AF before and after catheter ablation. Methods: Patients with symptomatic AF underwent implantation of an ICM with an automated AF detection algorithm 3 months before and 18 months after ablation. Patients kept a standardized diary to record symptoms of arrhythmia, and ICM data were downloaded every 3 months. All episodes were blindly adjudicated and correlated with the diary. Asymptomatic recurrences were ICM episodes of 2 minutes or longer with no associated diary symptoms. Results: Fifty patients had 2355 ICM episodes. Of these, 69.0% were true AF/atrial flutter (AFL)/atrial tachycardia (AT); 16.0%, sinus with extrasystoles; 11.0%, artifact; and 4.0%, sinus arrhythmia. Total AF/AFL/AT burden was reduced by 86% from a mean (SD) of 2.0 (0.5) h/d per patient before to 0.3 (0.2) h/d per patient after ablation (PϽ.001), and 56.0% of all episodes were asymp-tomatic. The ratio of asymptomatic to symptomatic AF episodes increased after ablation from 1.1 to 3.7 (P=.002). By symptoms alone, 29 of 50 patients (58%) were free of AF/AFL/AT after ablation compared with 23 of 50 (46%) using ICM-detected AF/AFL/AT recurrence. Asymptomatic episodes were more likely AFL/AT and were significantly shorter and slower, with lower heart rate variability. However, the postablation state was the strongest independent predictor of asymptomatic AF. Conclusions: The ratio of asymptomatic to symptomatic AF episodes increased from 1.1 before to 3.7 after ablation. Postablation state is the strongest predictor of asymptomatic AF. Symptoms alone underestimate postablation AF burden, with 12% of patients having asymptomatic recurrences only.

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Long-Term Quality of Life After Ablation of Atrial Fibrillation

Abstract: AF ablation produces sustained QoL improvement at 2 years in patients with and without recurrence. AF-specific symptom assessment more accurately reflects ablative efficacy.

Cited by 206 publications

References 22 publications

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

Effect of Catheter Ablation vs Medical Therapy on Quality of Life Among Patients With Atrial Fibrillation

Discerning the Incidence of Symptomatic and Asymptomatic Episodes of Atrial Fibrillation Before and After Catheter Ablation (DISCERN AF)

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