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Review
. 2020 Apr 2;2(4):286-295.
doi: 10.1016/j.cjco.2020.03.013. eCollection 2020 Jul.

Health-Related Quality of Life in Patients With Atrial Fibrillation Treated With Catheter Ablation or Antiarrhythmic Drug Therapy: A Systematic Review and Meta-analysis

Katherine S Allan  1   2 , Theresa Aves  1 , Shaunattonie Henry  2 , Laura Banfield  3 , J Charles Victor  4 , Paul Dorian  1   5   6 , Jeff S Healey  7 , Jason G Andrade  8   9 , Sandra L Carroll  2   7 , Michael H McGillion  2   7
Affiliations
Review

Health-Related Quality of Life in Patients With Atrial Fibrillation Treated With Catheter Ablation or Antiarrhythmic Drug Therapy: A Systematic Review and Meta-analysis

Katherine S Allan et al. CJC Open. .

Abstract
in English, French

Background: Catheter ablation (CA) is performed in patients with atrial fibrillation (AF) to reduce symptoms and improve health-related quality of life (HRQL).

Methods: This systematic review and meta-analysis of randomized controlled trials (RCTs) evaluated CA of any energy modality compared with antiarrhythmic drugs (AADs) using inverse-variance random-effects models. We searched for RCTs reporting HRQL and AF-related symptoms at 3, 6, 12, 24, 48, and 60 months after treatment as well as the number of repeat ablations.

Results: Of 15,878 records, we included 13 RCTs of CA vs AADs for the analyses of HRQL, 7 RCTs for the analyses of AF-related symptoms, and 13 RCTs for the number of repeat ablations. For the HRQL analyses at 3 months, there were significant increases in both the Physical Component Summary score (3 months' standardized mean difference = 0.58 [0.39-0.78]; P < 0.00001, I 2 = 6%, 3 trials, n = 443) and the Mental Component Summary score (3 months' standardized mean difference = 0.57 [0.37-0.77]; P < 0.00001, I 2 = 0%, 3 trials, n = 443), favouring CA over AADs. These differences were sustained at 12 months but not >24 months after randomization. Similar results were seen for AF-related symptoms. The number of repeat ablations and success rates after procedure varied considerably across trials.

Conclusions: Evidence from few trials suggests that CA improves physical and mental health and AF-related symptoms in the short term, but these benefits decrease with time. More trials, reporting both HRQL and AF-related symptoms, at consistent time points are needed to assess the effectiveness of CA for the treatment of AF.

Contexte: L’ablation par cathéter (AC) est réalisée chez les patients atteints de fibrillation auriculaire (FA) afin d’atténuer les symptômes et d’améliorer la qualité de vie liée à la santé (QVLS).

Méthodologie: Cette revue systématique et méta-analyse d’essais contrôlés à répartition aléatoire (ECRA) a permis d’évaluer l’AC, toutes modalités énergétiques confondues, comparativement aux agents antiarythmiques (AA) à l’aide de modèles à effets aléatoires à variance inverse. Nous avons recherché les ECRA qui faisaient état de la QVLS et des symptômes liés à la FA à 3, 6, 12, 24, 48 et 60 mois après le traitement et qui précisaient le nombre d’ablations répétées.

Résultats: À partir de 15 878 entrées, nous avons retenu 13 ECRA comparant l’AC à des AA pour l’analyse de la QVLS, 7 autres pour l’analyse des symptômes liés à la FA et 13 de plus aux fins de calcul du nombre d’ablations répétées. L’analyse de la QVLS à 3 mois indique une augmentation significative du score sommaire de la composante physique (différence moyenne normalisée à 3 mois = 0,58 [0,39-0,78]; p < 0,00001, I 2 = 6 %, 3 essais, n = 443) et du score sommaire de la composante mentale (différence moyenne normalisée à 3 mois = 0,57 [0,37-0,77]; p < 0,00001, I 2 = 0 %, 3 essais, n = 443), faisant pencher la balance en faveur de l’AC plutôt que des AA. Ces différences persistaient à 12 mois après la répartition aléatoire, mais pas aux moments d’évaluation ultérieurs (24, 48 et 60 mois). Des résultats similaires ont été observés au chapitre des symptômes liés à la FA. Le nombre d’ablations répétées et le taux de réussite postopératoire variaient considérablement d’un essai à l’autre.

Conclusions: Les données probantes de quelques essais donnent à penser que l’AC améliore la santé physique et mentale ainsi que les symptômes liés à la FA à court terme, mais que ces bienfaits s’atténuent avec le temps. D’autres essais faisant état de la QVLS et des symptômes liés à la FA, à des moments d’évaluation constants, devront être réalisés pour évaluer l’efficacité réelle de l’AC dans le traitement de la FA.

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Figures

Figure 1
Figure 1
Flow diagram of study selection.
Figure 2
Figure 2
Physical and Mental Component Summary scores at 3, 6, 12, and ≥48 months: as measured by the SF-36 (0-100). A positive change from baseline (right axis) to follow-up indicates an improvement in HRQL, whereas a negative change (left axis) indicates a worsening of HRQL. AAD, antiarrhythmic drug; CI, confidence interval; HRQL, health-related quality of life; RFA, radiofrequency ablation; SF-36, Short Form-36; SMD, standardized mean difference.
Figure 3
Figure 3
AF-symptom frequency at 3, 6, 12, 24, and 60 months: AF-symptom frequency as measured by the AF Symptom Frequency and Severity Checklist and the University of Toronto Atrial Fibrillation Severity Scale. A negative change (left axis) between baseline and follow-up indicates an improvement in symptoms, whereas a positive change (right axis) indicates a worsening of symptoms. AAD, antiarrhythmic drug; AF, atrial fibrillation; CI, confidence interval; RFA, radiofrequency ablation; SMD, standardized mean difference.
Figure 4
Figure 4
AF-symptom severity at 3, 6, 12, 24, and 60 months: AF-symptom severity as measured by the University of Toronto Atrial Fibrillation Severity Scale and AF Symptom Frequency and Severity Checklist (AFSS). A negative change (left axis) between baseline and follow-up indicates an improvement in symptoms, whereas a positive change (right axis) indicates a worsening of symptoms. AAD, antiarrhythmic drug; AF, atrial fibrillation; CI, confidence interval; RFA, radiofrequency ablation; SMD, standardized mean difference.
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References

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