title: Long-term quality of life after ablation of atrial fibrillation the impact of recurrence, symptom relief, and placebo effect.
abstract: OBJECTIVE
  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.
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Anita
authors.initials: A
authors.lastname: Wokhlu
authors.forename: Kristi H
authors.initials: KH
authors.lastname: Monahan
authors.forename: David O
authors.initials: DO
authors.lastname: Hodge
authors.forename: Samuel J
authors.initials: SJ
authors.lastname: Asirvatham
authors.forename: Paul A
authors.initials: PA
authors.lastname: Friedman
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Munger
authors.forename: David J
authors.initials: DJ
authors.lastname: Bradley
authors.forename: Christine M
authors.initials: CM
authors.lastname: Bluhm
authors.forename: Janis M
authors.initials: JM
authors.lastname: Haroldson
authors.forename: Douglas L
authors.initials: DL
authors.lastname: Packer
mesh_terms: D000223:Adaptation, Psychological; D000367:Age Factors; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000523:psychology* / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods* / Q000523:psychology; D015331:Cohort Studies; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D015990:Placebo Effect; D011183:Postoperative Complications / Q000503:physiopathology; D011446:Prospective Studies; D011788:Quality of Life; D012008:Recurrence; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D018434:Sickness Impact Profile; D013997:Time Factors; D016896:Treatment Outcome