title: Mortality, morbidity, and quality of life after circumferential pulmonary vein ablation for atrial fibrillation: outcomes from a controlled nonrandomized long-term study.
abstract: OBJECTIVE
  This study was designed to investigate the potential of circumferential pulmonary vein (PV) ablation for atrial fibrillation (AF) to maintain sinus rhythm (SR) over time, thus reducing mortality and morbidity while enhancing quality of life (QoL).
  
  
  BACKGROUND
  Circumferential PV ablation is safe and effective, but the long-term outcomes and its impact on QoL have not been assessed or compared with those for medical therapy.
  
  
  METHODS
  We examined the clinical course of 1,171 consecutive patients with symptomatic AF who were referred to us between January 1998 and March 2001. The 589 ablated patients were compared with the 582 who received antiarrhythmic medications for SR control. The QoL of 109 ablated and 102 medically treated patients was measured with the SF-36 survey.
  
  
  RESULTS
  Median follow-up was 900 days (range 161 to 1,508 days). Kaplan-Meier analysis showed observed survival for ablated patients was longer than among patients treated medically (p < 0.001), and not different from that expected for healthy persons of the same gender and calendar year of birth (p = 0.55). Cox proportional-hazards model revealed in the ablation group hazard ratios of 0.46 (95% confidence interval [CI], 0.31 to 0.68; p < 0.001) for all-cause mortality, of 0.45 (95% CI, 0.31 to 0.64; p < 0.001) for morbidities mainly due to heart failure and ischemic cerebrovascular events, and of 0.30 (95% CI, 0.24 to 0.37; p < 0.001) for AF recurrence. Ablated patients' QoL, different from patients treated medically, reached normative levels at six months and remained unchanged at one year.
  
  
  CONCLUSIONS
  Pulmonary vein ablation improves mortality, morbidity, and QoL as compared with medical therapy. Our findings pave the way for randomized trials to prospect a wider application of ablation therapy for AF.
authors.affiliation: Clinical Cardiac Electrophysiology and Pacing Unit, Department of Cardiology, San Raffaele University Hospital, Milan, Italy
authors.forename: Carlo
authors.initials: C
authors.lastname: Pappone
authors.forename: Salvatore
authors.initials: S
authors.lastname: Rosanio
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Augello
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Gallus
authors.forename: Gabriele
authors.initials: G
authors.lastname: Vicedomini
authors.forename: Patrizio
authors.initials: P
authors.lastname: Mazzone
authors.forename: Simone
authors.initials: S
authors.lastname: Gulletta
authors.forename: Filippo
authors.initials: F
authors.lastname: Gugliotta
authors.forename: Alessia
authors.initials: A
authors.lastname: Pappone
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Santinelli
authors.forename: Valter
authors.initials: V
authors.lastname: Tortoriello
authors.forename: Simone
authors.initials: S
authors.lastname: Sala
authors.forename: Alberto
authors.initials: A
authors.lastname: Zangrillo
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Crescenzi
authors.forename: Stefano
authors.initials: S
authors.lastname: Benussi
authors.forename: Ottavio
authors.initials: O
authors.lastname: Alfieri
mesh_terms: D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000401:mortality / Q000523:psychology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods; D002423:Cause of Death; D002561:Cerebrovascular Disorders / Q000209:etiology; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000209:etiology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D009017:Morbidity; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011667:Pulmonary Veins / Q000601:surgery*; D011788:Quality of Life; D012008:Recurrence; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents