Documented atrial fibrillation recurrences after pulmonary vein isolation are associated with diminished quality of life

Obese patients exhibit a greater enhancement in mental health-related quality of life compared to non-obese patients following thoracoscopic ablation of atrial fibrillation

Background

Obesity is an important risk factor for atrial fibrillation (AF) development and progression. Furthermore, obesity reduces health-related quality of life (HRQoL), an essential indicator for treatment efficacy of AF ablation. Nevertheless, the extent to which obesity influences changes in HRQoL and the recurrence of AF following ablation, especially thoracoscopic AF ablation, remains largely unexplored.

Aims

We assessed in obese vs. non-obese patients undergoing thoracoscopic AF ablation: (1) HRQoL upon ablation, (2) AF recurrence incidence, (3) the association between recurrence incidence and HRQoL.

Methods & results

408 prospectively enrolled patients were included for analysis. Heart rhythm was systematically monitored during follow-up. AF recurrence was defined as any atrial tachyarrhythmia episode > 30 s. HRQoL and recurrence incidence were assessed for normal weight (BMI ≤ 24.9 kg/m2), overweight (25.0-29.9 kg/m2) and obese (≥30.0 kg/m2) patients. HRQoL was assessed at baseline and 1-year follow-up. Obese patients scored lower in pre-operative HRQoL across 6/8 subscales vs. non-obese patients (p < 0.01-0.05). While HRQoL increased in all patients, obese patients showed a trend towards an even greater improvement of mental HRQoL (p = 0.07) vs. non- obese patients. In obesity, mental HRQoL increased similarly for those with and without AF recurrence (p = 0.78), whereas in non-obese patients, AF recurrence was associated with less improved mental HRQoL (p = 0.03). AF recurrence at 1-year was similar between all weight groups (72.4%, 68.0%, 70.4%, p = 0.69).

Conclusions

After thoracoscopic ablation, obese patients experience a comparable incidence of AF recurrence as non-obese patients. Interestingly, obese patients also exhibit a more significant enhancement in mental quality of life, regardless of whether AF recurs or not.

Sex Differences in Quality of Life in Patients With Atrial Fibrillation: A Systematic Review

Background The goal of this literature review was to assess sex differences in the quality of life (QoL) in patients with atrial fibrillation ( AF ) and, if possible, to determine if these are due to AF . Methods and Results The electronic database PubMed was searched on January 23, 2018, using the search terms "QoL", gender differences, " AF " female, and gender to find potential articles that assessed sex differences in QoL in AF patients. In all, 851 articles were identified, from which 25 original studies were eligible for this systematic review. Female AF patients were found to have poorer QoL and more symptoms than male AF patients. They scored lower, predominantly on the physical component score of the Medical Outcomes Study Short-Form 36 Health Survey. Conclusions The available literature consistently describes poorer QoL in female AF patients but does not clearly address whether this is a reflection of sex differences seen in the general population or is related to AF per se. It is also questionable whether the relatively poorer QoL in women is large enough to be of clinical importance.

Patient-Reported Outcomes in Relation to Continuously Monitored Rhythm Before and During 2 Years After Atrial Fibrillation Ablation Using a Disease-Specific and a Generic Instrument

BACKGROUND

Atrial fibrillation (AF) ablation improves patient-reported outcomes, irrespective of mode of intermittent rhythm monitoring. We evaluated the use of an AF-specific and a generic patient-reported outcomes instrument during continuous rhythm monitoring 2 years after AF ablation.

METHODS AND RESULTS

Fifty-four patients completed the generic 36-Item Short-Form Health Survey and the AF-specific AF6 questionnaires before and 6, 12, and 24 months after AF ablation. All patients underwent continuous ECG monitoring via an implantable loop recorder. The generic patient-reported outcomes scores were compared with those of a Swedish age- and sex-matched population. After ablation, both summary scores reached normative levels at 24 months, while role-physical and vitality remained lower than norms. Responders to ablation (AF burden <0.5%) reached the norms in all individual 36-Item Short-Form Health Survey domains, while nonresponders (AF burden >0.5%) reached norms only in social functioning and mental component summary. All AF6 items and the sum score showed moderate to large improvement in both responders and nonresponders, although responders showed significantly greater improvement in all items except item 1 from before to 24 months after ablation. Higher AF burden was independently associated with poorer physical component summary and AF6 sum score.

CONCLUSIONS

The AF-specific AF6 questionnaire was more sensitive to changes related to AF burden than the generic 36-Item Short-Form Health Survey. Patients improved as documented by both instruments, but a higher AF burden after ablation was associated with poorer AF-specific patient-reported outcomes and poorer generic physical but not mental health. Our results support the use of an AF-specific instrument, alone or in combination with a generic instrument, to assess the effect of ablation.

CLINICAL TRIAL REGISTRATION

URL: https://www.clinicaltrials.gov. Unique identifier: NCT00697359.