title: [Change of quality of life and NYHA class in patients with advanced heart failure and permanent atrial fibrillation after 12-months period from upgrade of pacing system].
abstract: There is no research on the change of quality of life and NYHA classification after pacing system upgrade performed as a treatment of advanced heart failure during a long observation period in a particular population of patients with long-term apical right ventricular pacing, permanent atrial fibrillation and complete atrio-ventricular block. The aim of the study was evaluation of changes in quality of life and NYHA class in group of patients in which upgrade from right ventricular apical pacing to biventricular or bifocal right ventricular pacing was done.
  
  
  METHODS
  Evaluation of quality of life was performed in a chosen group of 27 patients (20 males, mean age 71.2) who completed the 12-month observation period. Quality of life was assessed by the Short Form-36 (SF-36) questionnaire. The first examination was carried out before the planned pacing system upgrade, that is, when advanced heart failure appeared in the course of permanent atrial fibrillation and right ventricular apical pacing present for a long time (on average 7.7 years). The change of quality of life after 12-month period of upgrade pacing system was analyzed. A comparison of patient's self assessment (as far as physical aspect of quality of life is concerned - Physical Component Summary - PCS) with doctor's interview concerning NYHA classification was performed. Additionally quality of life pointed out by a patient was analyzed in relation to the diseases most common in this population: hypertension, diabetes mellitus and renal failure. Because the questionnaires were completed by the patients personally without the third party, the assessment referred to mistakes in filling in the questionnaires (quantity of missed questions and incorrect marking the answers by adding individual comments) in relation to patients' age.
  
  
  RESULTS
  In 12-month follow-up after pacing system upgrade, improvement of quality of life was found in 48.1% of patients. Assessment of physical aspect of quality of life was possible due to SF-36. Improvement occurred in 55.5% of patients, however in relation with NYHA classification improvement appeared in 51.8% of patients. Improvement in NYHA was in significant correlation with improvement in physical aspect of life (p = 0.025), especially in the subgroup treated by pacing system upgrade to bifocal right ventricular pacing (p = 0.0066). In the subgroup with improvement, hypertension and diabetes were less frequent, however frequency of renal failure was greater, than in the subgroup without quality of live improvement. Both before and after pacing system upgrade, there was no significant connection (only a trend) between the number of mistakes done during self-completion of the questionnaires and patients' age.
  
  
  CONCLUSIONS
  In 12-month follow-up after pacing system upgrade, improvement of quality of life was found in 48.1% of patients. There exists a significant correlation between the improvement of physical efficiency in NYHA class and the improvement in physical aspect of quality of life in patients' self assessment (p = 0.025). In the subgroup treated by pacing system upgrade to bifocal right ventricular pacing this correlation is especially strong (p = 0.0066).
authors.affiliation: Jagiellonian University, Collegium Medicum, Department of Electrocardiology, John Paul II Hospital, Kraków, Poland. barbara_malecka@go2.pl
authors.forename: Barbara
authors.initials: B
authors.lastname: Małecka
authors.forename: Andrzej
authors.initials: A
authors.lastname: Zabek
authors.forename: Jacek
authors.initials: J
authors.lastname: Lelakowski
authors.forename: Janusz
authors.initials: J
authors.lastname: Małecki
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000453:epidemiology / Q000628:therapy*; D002304:Cardiac Pacing, Artificial / Q000523:psychology*; D015984:Causality; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D006973:Hypertension / Q000453:epidemiology* / Q000517:prevention & control; D015994:Incidence; D008297:Male; D011159:Population Surveillance; D011788:Quality of Life; D051437:Renal Insufficiency / Q000453:epidemiology* / Q000517:prevention & control; D012647:Self-Assessment; D011795:Surveys and Questionnaires; D016896:Treatment Outcome