title: Quality-of-life benefits of catheter ablation of persistent atrial fibrillation: a reanalysis of data from the SARA study.
abstract: OBJECTIVE
  The recently published SARA study was a prospective, multi-centre randomized controlled trial that compared CA to antiarrhythmic drug therapy (ADT) in 146 patients with persistent atrial fibrillation (AF). The study found that recurrence of AF or atrial flutter occurred significantly less often in the CA arm compared to the ADT arm (29.6% vs. 56.3%, p = 0.002). Despite this clear superiority in terms of efficacy, the authors were not able to demonstrate a corresponding Quality of Life (QoL) improvement. We sought to investigate this apparent disparity using alternative analytical methods.
  
  
  RESULTS
  We were able to show that a high coefficient of variation existed for all QoL measures at each time point which may explain the lack of statistical difference originally reported. We reanalyzed the raw QoL data from the SARA study using paired sample t-tests for the change in QOL for individual patients between baseline and 12 month (final) follow up. For patients randomized to ADT the difference in QoL after 12 months was not significant for any of the four QoL domains (global, physical, psychological and sexual) whereas for patients randomized to CA all comparisons were significant (global, p < 0.001; physical, p = 0.001; psychological, p < 0.001; sexual, p = 0.003).
  
  
  CONCLUSIONS
  In the SARA study, after 12 months' follow up, CA significantly improved QoL for patients with persistent AF whereas medical therapy had no appreciable effect.
authors.affiliation: The Institute of Cardiovascular Medicine and Science, Research Unit, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool L14 3PE, UK Imperial College London, London, SW7 2AZ, UK.
authors.forename: Gareth J
authors.initials: GJ
authors.lastname: Wynn
authors.affiliation: The Institute of Cardiovascular Medicine and Science, Research Unit, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool L14 3PE, UK Imperial College London, London, SW7 2AZ, UK.
authors.forename: Moloy
authors.initials: M
authors.lastname: Das
authors.affiliation: Department of Biostatistics and Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool L69 3BX, UK.
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Bonnett
authors.affiliation: The Institute of Cardiovascular Medicine and Science, Research Unit, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool L14 3PE, UK Imperial College London, London, SW7 2AZ, UK dhiraj.gupta@lhch.nhs.uk.
authors.forename: Dhiraj
authors.initials: D
authors.lastname: Gupta
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*; D017115:Catheter Ablation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life / Q000523:psychology*; D012008:Recurrence; D060728:Reproductive Health; D013223:Statistics as Topic; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents
keywords: Ablation; Atrial fibrillation; Persistent atrial fibrillation; Quality of life