Quality of life following catheter ablation
MUNICH, GERMANY. Several studies have reported that the quality of life (QoL) of atrial fibrillation (AF) patients is significantly reduced compared to that of age-matched healthy control subjects. Doctors at the German Heart Center now report that QoL shows substantial improvement after a catheter ablation. Their study involved 133 patients who underwent catheter ablation at the Center between July 2004 and August 2006. The average age of the patients was 57 years, 74% were men, and 65% had paroxysmal AF. Valvular heart disease was fairly common among the study participants at 29%. Fourteen percent had coronary artery disease or had suffered a heart attack, and 51% had hypertension.

All patients underwent a pulmonary vein isolation (PVI) procedure with additional lesions as required. After a 3-month blanking period, 65% of patients with paroxysmal AF and 46% of those with persistent AF were in normal sinus rhythm without the use of antiarrhythmic drugs. Thirty-nine percent of patients underwent a repeat procedure because of arrhythmia recurrence after a mean follow-up of 11 months. At the last follow-up (a median of 4.3 years after the initial procedure), 66% of paroxysmal afibbers and 50% of persistent afibbers were in normal sinus rhythm without the use of antiarrhythmics. Oral anticoagulation was discontinued after 6 months in all patients without AF recurrence provided their CHADS2 score was below 2.

Prior to the ablation, all patients filled out 7 detailed questionnaires designed to provide a quantitative estimate of their baseline QoL. Three of the questionnaires were specific to AF and covered such aspects as symptoms, severity of episodes, and self-perceived impact of AF. The other 4 questionnaires were generic in nature and dealt with such QoL factors as depression, energy level, sleep quality, mood and general interest. The questionnaires were repeated 3 months and an average of 4.3 years after the initial ablation procedure. After 3 months, all patients regardless of AF type and ablation outcome, showed significant improvement on all 4 generic questionnaires and in 2 of the AF specific questionnaires (changes in self-perceived impact of AF were not statistically significant). Not surprisingly, QoL improvement was more pronounced among patients with a successful ablation than among those with an unsuccessful one. The improvement in QoL continued to be statistically highly significant at 4.3 years, irrespective of AF type and ablation outcome. However, patients with a successful ablation had significantly greater improvement in QoL than did those with an unsuccessful procedure, especially in regard to depression, AF symptoms, and AF severity.

The authors conclude that, "Ablation for AF significantly improves QoL irrespective of ablation success during short- and long-term follow-up. The degree of QoL improvement is significantly correlated with ablation success during long-term follow-up in the questionnaires especially designed for AF and in the depression questionnaire. Thus, the longevity of QoL improvement after catheter ablation potentially strengthens the argument for ablation in patients with symptomatic AF."
Fichtner, S, et al. Prospective assessment of short- and long-term quality of life after ablation for atrial fibrillation. Journal of Cardiovascular Electrophysiology, Vol. 23, February 2012, pp. 121-27

Editor's comment: The results of the German Heart Center QoL survey confirm the findings of our 2007 Ablation/Maze Survey as per the following excerpt:

Although the main concern of the medical profession when it comes to lone atrial fibrillation is stroke risk, the overwhelming concern of the patient is quality of life. As all afibbers know, being in permanent afib, or awaiting the next episode in a state of anxiety, has a devastating effect on one's quality of life and radically changes the life of those nearest and dearest to us.

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.