ROCHESTER, MINNESOTA. It is well established that people with atrial fibrillation have impaired quality of life (QoL). What has not been investigated is the extent to which a successful or unsuccessful catheter ablation impacts on QoL. Researchers at the Mayo Clinic have just reported the results of a study involving 323 afibbers who had undergone one or more ablations with the intent of curing AF. All patients underwent circumferential pulmonary vein isolation with additional lesion lines as needed. Two years after their last procedure, 233 patients (72%) were afib-free without the use of antiarrhythmics (complete success), 48 patients (15%) were able to remain in sinus rhythm with the aid of previously ineffective antiarrhythmics (partial success), and the remaining 42 patients (13%) were still having afib episodes (failure). Eighteen percent of the groups underwent a repeat ablation an average of two years after their initial procedure.
All study participants completed QoL questionnaires prior to their first ablation and 2 years after their last procedure. Health-related QoL was assessed with the Medical Outcomes Study Short Form-36 (SF-36) which measures health on 8 different scales with a range from 0 (worst health) to 100 best health). The participants also completed the Mayo AF-Specific Symptom Inventory (MAFSI) which seeks to determine frequency of common AF symptoms (palpitations, dizziness, shortness of breath, fatigue, etc) over a 6-month period using a scale of 0 (never) to 4 (always).
The average baseline (prior to ablation) SF-36 score was 64 increasing to 81 three months after the procedure and maintaining this level at the 1- and 2-year marks. The physical component score of SF-36 increased from 59 to 76 and the mental component score rose from 65 to 80. The increase in these scores was somewhat less for patients experiencing recurrences and significantly less for those still taking antiarrhythmics. Improvement in QoL was also significantly less for afibbers who remained on warfarin. Frequency of common AF symptoms as measured by MAFSI decreased from 14 prior to the ablation to 5 following. Symptoms improvements were particularly marked in the case of palpitations, tiredness, and ability to exercise. The degree of improvement in symptoms as measured with the MAFSI scale depended highly on ablation outcome. In the case of complete success (no AF, no antiarrhythmics) the improvement averaged 9.5 points as compared to only 5.6 points among participants still needing antiarrhythmics for control, and 3.4 points among those experiencing AF recurrence. Being on warfarin 2 years following ablation reduced SF-36 score by an average of 10 points, while being obese reduced it by 6.8 points. A total of 43 patients experienced major procedural complications. These, somewhat surprisingly, did not affect QoL at 2 years post-procedure.
Wokhlu, A, et al. Long-term quality of life after ablation of atrial fibrillation. Journal of the American College of Cardiology, Vol. 55, No. 21, May 25, 2010, pp. 2308-16
Editor's comment: The conclusion of the Mayo Clinic study that a RF ablation improves QoL to some extent irrespective of outcome supports the conclusion from our 2007 Ablation/Maze Survey. "Considering quality of life improvement rather than strictly success or failure of RF ablation procedures, it becomes clear that even a failed ablation may improve life quality. The average complete success rate found in this survey (after an average 1.3 procedures) is 54%. Adding to this partial success (where afib is kept at bay with antiarrhythmics) brings the percentage of afibbers whose lives have been improved through RF ablation to 65%. Further considering that about 70% of ablatees whose procedure failed still reduced their afib burden by at least 50% brings one to the conclusion that RF ablation, whether successful or not, is likely to improve quality of life in close to 90% of those undergoing the procedure. A significant portion of the remaining 10% may, however, see a worsening of their condition or may experience a serious adverse event."