title: Catheter ablation of asymptomatic longstanding persistent atrial fibrillation: impact on quality of life, exercise performance, arrhythmia perception, and arrhythmia-free survival.
abstract: BACKGROUND
  Impact of catheter ablation on exercise performance, quality of life (QoL) and symptom perception in asymptomatic longstanding persistent AF (LSP-AF) patients has not been reported yet.
  
  
  RESULTS
  Sixty-one consecutive patients (mean age 62 ±13 years, 71% males) with asymptomatic LSP-AF undergoing first catheter ablation were enrolled. Extended pulmonary vein antrum isolation plus ablation of complex fractionated atrial electrograms and nonpulmonary vein triggers was performed in all. QoL survey was taken at baseline and 12-months postablation, using Short Form-36 (SF-36). Information on arrhythmia perception was obtained using a standard questionnaire and corroborating symptoms with documented evidence of arrhythmia. Exercise tests were performed on 38 patients at baseline and 5 months after procedure. Recurrence was assessed using event recorder, cardiology evaluation, electrocardiogram, and 7-day holter monitoring. After 20 ± 5 months follow-up, 36 (57%) patients remained recurrence-free off-AAD. Of the 25 patients experiencing recurrence, 21 (84%) were symptomatic. Compared to baseline, follow-up SF-36 scores improved significantly in many measures. For patients with successful ablation, physical component summary (PCS) and mental component summary (MCS) demonstrated substantial improvement (
  64.2 ± 22.3 to 70.1 ± 18.6 [P = 0.041]; PCS: 62.6 ± 18.4 to 70.0 ± 14.4 [P = 0.032]). Postablation exercise study in recurrence-free patients showed significant reduction in resting and peak heart rate (75 ± 11 vs. 90 ± 17 and 132 ± 20 vs. 154.5 ± 36, respectively, P < 0.001), increase in peak oxygen pulse (13.4 ± 3 vs. 18.9 ± 16 mL/beat, Δ5.5 ± 15, P = 0.001), peak VO2 /kg (19.7 ± 5 to 23.4 ± 13 mL/kg/min [Δ 3.7 ± 10, P = 0.043]), and corresponding MET (5.6 ± 1 to 6.7 ± 4 [Δ1.1 ± 3, P = 0.03]). No improvement was observed in patients with failed procedures.
  
  
  CONCLUSIONS
  Successful ablation improves exercise performance and QoL in asymptomatic LSP-AF patients.
authors.affiliation: Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA; College of Natural Sciences, University of Texas at Austin, Texas, USA.
authors.forename: Sanghamitra
authors.initials: S
authors.lastname: Mohanty
authors.forename: Pasquale
authors.initials: P
authors.lastname: Santangeli
authors.forename: Prasant
authors.initials: P
authors.lastname: Mohanty
authors.forename: Luigi
authors.initials: L
authors.lastname: Di Biase
authors.forename: Shawna
authors.initials: S
authors.lastname: Holcomb
authors.forename: Chintan
authors.initials: C
authors.lastname: Trivedi
authors.forename: Rong
authors.initials: R
authors.lastname: Bai
authors.forename: David
authors.initials: D
authors.lastname: Burkhardt
authors.forename: Richard
authors.initials: R
authors.lastname: Hongo
authors.forename: Steven
authors.initials: S
authors.lastname: Hao
authors.forename: Salwa
authors.initials: S
authors.lastname: Beheiry
authors.forename: Francesco
authors.initials: F
authors.lastname: Santoro
authors.forename: Giovanni
authors.initials: G
authors.lastname: Forleo
authors.forename: Joseph G
authors.initials: JG
authors.lastname: Gallinghouse
authors.forename: Rodney
authors.initials: R
authors.lastname: Horton
authors.forename: Javier E
authors.initials: JE
authors.lastname: Sanchez
authors.forename: Shane
authors.initials: S
authors.lastname: Bailey
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Hranitzky
authors.forename: Jason
authors.initials: J
authors.lastname: Zagrodzky
authors.forename: Andrea
authors.initials: A
authors.lastname: Natale
mesh_terms: D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D001294:Attitude to Health; D017115:Catheter Ablation / Q000523:psychology* / Q000592:standards*; D002908:Chronic Disease; D018572:Disease-Free Survival; D005080:Exercise Test / Q000523:psychology / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D015995:Prevalence; D011788:Quality of Life / Q000523:psychology*; D012307:Risk Factors; D013781:Texas / Q000453:epidemiology; D016896:Treatment Outcome
keywords: arrhythmia perception; asymptomatic longstanding persistent AF; exercise performance; quality of life