Author + information
- Received August 5, 2009
- Revision received November 23, 2009
- Accepted January 2, 2010
- Published online May 25, 2010.
- Anita Wokhlu, MD,
- Kristi H. Monahan, RN,
- David O. Hodge, MS,
- Samuel J. Asirvatham, MD,
- Paul A. Friedman, MD,
- Thomas M. Munger, MD,
- David J. Bradley, MD, PhD,
- Christine M. Bluhm, RN,
- Janis M. Haroldson, RN and
- Douglas L. Packer, MD⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. Douglas L. Packer, Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905
Objectives We sought to determine the relationship between atrial fibrillation (AF) ablation efficacy, quality of life (QoL), and AF-specific symptoms at 2 years.
Background Although the primary goal of AF ablation is QoL improvement, this effect has yet to be demonstrated in the long term.
Methods A total of 502 symptomatic AF ablation recipients were prospectively followed for recurrence, QoL, and AF symptoms.
Results In 323 patients with 2 years of follow-up, 72% achieved AF elimination off antiarrhythmic drugs (AADs), 15% achieved AF control with AADs, and 13% had recurrent AF. The physical component summary scores of the Medical Outcomes Study Short Form 36 increased from 58.8 ± 20.1 to 76.2 ± 19.2 (p < 0.001) and the mental component summary scores of the Short Form 36 increased from 65.3 ± 18.6 to 79.8 ± 15.8 (p < 0.001). Post-ablation QoL improvements were noted across ablation outcomes, including recurrent AF (change in physical component summary: 12.1 ± 19.7 and change in mental component summary: 9.7 ± 17.9), with no significant differences in QoL improvement across 3 ablative efficacy outcomes. However, in 103 patients who completed additional assessment with Mayo AF Symptom Inventories (on a scale of 0 to 48), those with AF elimination off AADs had a change in AF symptom frequency score of −9.5 ± 6.3, which was significantly higher than those with AF controlled with AADs (−5.6 ± 3.8, p = 0.03) or those with recurrent AF (−3.4 ± 8.4, p = 0.02). Independent predictors of limited QoL improvement included higher baseline QoL, obesity, and warfarin use at follow-up.
Conclusions AF ablation produces sustained QoL improvement at 2 years in patients with and without recurrence. AF-specific symptom assessment more accurately reflects ablative efficacy.
This study is funded by the Mayo Clinician Investigator Awardto Dr. Packer. Dr. Asirvatham receives honoraria from Boston Scientific, St. Jude Medical, Biotronik, and Medtronic and serves as a consultant for Sanofi-Aventis. Dr. Friedman receives research funding from Bard, St. Jude Medical, Medtronic, Boston Scientific, and Pfizer; intellectual property rights for Bard EP, Hewlett Packard, Medical Positioning, Inc., Aegis Medical, and NeoChord; and has served as a speaker/consultant for Medtronic, Boston Scientific, and St. Jude Medical. Dr. Packer in the past 12 months has provided consulting services for Biosense Webster, Inc., Boston Scientific, CyberHeart, Medtronic, Inc., nContact, Sanofi-Aventis, St. Jude Medical, and Toray Industries; he received no personal compensation for these consulting activities. Dr. Packer receives research funding from the National Institutes of Health, Medtronic, Inc., CryoCath, Siemens AG, EP Limited, St. Jude Medical, Minnesota Partnership for Biotechnology and Medical Genomics/University of Minnesota, Biosense Webster, Inc.and Boston Scientific. Mayo Clinic and Drs. Packer and Richard Robb have a financial interest in mapping technology. In accordance with the Bayh-Dole Act, this technology has been licensed to St. Jude Medical, and Mayo Clinic and Drs. Packer and Robb have received annual royalties greater than $10,000, the federal threshold for significant financial interest.
- Received August 5, 2009.
- Revision received November 23, 2009.
- Accepted January 2, 2010.
- American College of Cardiology Foundation