title: A prospective randomized multicenter comparison on health-related quality of life: the value of add-on arrhythmia surgery in patients with paroxysmal, permanent or persistent atrial fibrillation undergoing valvular and/or coronary bypass surgery.
abstract: BACKGROUND
  This is a multicenter, prospective, randomized controlled trial to determine the effect of add-on arrhythmia surgery on health-related quality of life during 1-year follow-up of cardiac surgery patients with atrial fibrillation.
  
  
  METHODS
  150 patients with documented atrial fibrillation were randomly assigned to undergo cardiac surgery with or without add-on surgery. Patients completed quality of life questionnaires, comprising the RAND 36-item Health Survey 1.0 (SF-36), Multidimensional Fatigue Inventory-20 (MFI-20) and EuroQoL (EQ-5D and VAS) at baseline and 3, 6, and 12 months following operation.
  
  
  RESULTS
  132 patients completed the questionnaires at a minimum of one time-point during follow-up. At baseline patient characteristics, operative data and health-related quality of life were comparable. At 12-month follow-up 62 patients were free of atrial fibrillation without significant differences between groups (P = 0.28). Conversion to SR occurred in 69.8% (37/53) of patients with paroxysmal AF, in 28.2% (11/39) of patients with permanent AF and in 44.4% (12/27) of patients in persistent AF. Cardiac surgery in general resulted in an overall improvement of the RAND SF-36 and the MFI-20. However, the EQ-5D showed a significant deterioration in the subscale Pain/Discomfort for both groups (P < 0.001), with a significant worse outcome for the control group (P = 0.006).
  
  
  CONCLUSIONS
  Health-related quality of life in patients with paroxysmal, permanent and persistent atrial fibrillation improves after cardiac surgery regardless of giving add-on surgery or not, but this improvement is presumably more affected by treating the underlying heart disease than by restoring sinus rhythm.
authors.affiliation: Department of Cardiothoracic Surgery, University Hospital Maastricht, Maastricht, The Netherlands. n.van.breugel@mumc.nl
authors.forename: H N A M
authors.initials: HN
authors.lastname: Van Breugel
authors.forename: F H M
authors.initials: FH
authors.lastname: Nieman
authors.forename: R E
authors.initials: RE
authors.lastname: Accord
authors.forename: G A P G
authors.initials: GA
authors.lastname: Van Mastrigt
authors.forename: J F M A
authors.initials: JF
authors.lastname: Nijs
authors.forename: J L
authors.initials: JL
authors.lastname: Severens
authors.forename: R
authors.initials: R
authors.lastname: Vrakking
authors.forename: J G
authors.initials: JG
authors.lastname: Maessen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000401:mortality / Q000523:psychology* / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D002315:Cardiopulmonary Bypass; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006351:Heart Valves / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010496:Pericardium / Q000601:surgery; D011446:Prospective Studies; D011788:Quality of Life; D011795:Surveys and Questionnaires; D016896:Treatment Outcome