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Randomized Controlled Trial
. 2020 Dec;106(24):1919-1926.
doi: 10.1136/heartjnl-2020-316612. Epub 2020 Oct 12.

Changes in quality of life, cognition and functional status following catheter ablation of atrial fibrillation

Jonathan P Piccini  1 , Derick M Todd  2 , Tyler Massaro  3 , Aimee Lougee  4 , Karl Georg Haeusler  5   6 , Benjamin Blank  6 , Joseph Paul de Bono  7 , David J Callans  8 , Arif Elvan  9 , Thomas Fetsch  10 , Isabelle Van Gelder  11 , Philip Gentlesk  12 , Massimo Grimaldi  13 , Jim Hansen  14 , Gerhard Hindricks  15 , Hussein Al-Khalidi  16 , Lluis Mont  17 , Jens Cosedis Nielsen  18 , Georg Noelker  19 , Tom De Potter  20 , Daniel Scherr  21   22 , Ulrich Schotten  23 , Sakis Themistoclakis  24 , Johan Vijgen  25 , Luigi Di Biase  26 , Paulus Kirchhof  6   7   27
Affiliations
Randomized Controlled Trial

Changes in quality of life, cognition and functional status following catheter ablation of atrial fibrillation

Jonathan P Piccini et al. Heart. 2020 Dec.

Abstract

Objective: To investigate changes in quality of life (QoL), cognition and functional status according to arrhythmia recurrence after atrial fibrillation (AF) ablation.

Methods: We compared QoL, cognition and functional status in patients with recurrent atrial tachycardia (AT)/AF versus those without recurrent AT/AF in the AXAFA-AFNET 5 clinical trial. We also sought to identify factors associated with improvement in QoL and functional status following AF ablation by overall change scores with and without analysis of covariance (ANCOVA).

Results: Among 518 patients who underwent AF ablation, 154 (29.7%) experienced recurrent AT/AF at 3 months. Patients with recurrent AT/AF had higher mean CHA2DS2-VASc scores (2.8 vs 2.3, p<0.001) and more persistent forms of AF (51 vs 39%, p=0.012). Median changes in the SF-12 physical (3 (25th, 75th: -1, 8) vs 1 (-5, 8), p=0.026) and mental scores (2 (-3, 9) vs 0 (-4, 5), p=0.004), EQ-5D (0 (0,2) vs 0 (-0.1, 0.1), p=0.027) and Karnofsky functional status scores (10 (0, 10) vs 0 (0, 10), p=0.001) were more favourable in patients without recurrent AT/AF. In the overall cohort, the proportion with at least mild cognitive impairment (Montreal Cognitive Assessment <26) declined from 30.3% (n=157) at baseline to 21.8% (n=113) at follow-up. ANCOVA identified greater improvement in Karnofsky functional status (p<0.001) but not SF-12 physical (p=0.238) or mental scores (p=0.065) in those without recurrent AT/AF compared with patients with recurrent AT/AF.

Conclusions: Patients without recurrent AT/AF appear to experience greater improvement in functional status but similar QoL as those with recurrent AT/AF after AF ablation.

Keywords: atrial arrhythmia ablation procedures; atrial fibrillation; quality and outcomes of care.

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Conflict of interest statement

Competing interests: The study was sponsored by the AF-NET with funding from BMS-Pfizer and the European Union. JPP receives grants for clinical research from Abbott, ARCA biopharma, Boston Scientific, Gilead, Janssen Pharmaceuticals and NHLBI and serves as a consultant to Abbott, Allergan, ARCA Biopharma, Bayer, Biotronik, GSK, Johnson & Johnson, Medtronic, Motif Bio, Sanofi and Phillips. DMT receives speaking honoraria from Boston Scientific, Medtronic and Abbott. KGH reports study grants by Bayer and Sanofi-Aventis, lecture fees/advisory board fees from Sanofi-Aventis, Pfizer, Bristol-Myers-Squibb, Boehringer Ingelheim, Daiichi Sankyo, Edwards Lifesciences, Biotronik and Medtronic. JV reports speaker honoraria from Abbott. PK receives research support for basic, translational and clinical research projects from European Union, British Heart Foundation, Leducq Foundation, Medical Research Council (UK) and German Centre for Cardiovascular Research, from several drug and device companies active in atrial fibrillation and has received honoraria from several such companies in the past. JCN is supported by a grant from the Novo Norvodisk Foundation (NNF16OC0018658). PK is listed as inventor on two patents held by University of Birmingham (Atrial Fibrillation Therapy WO 2015140571, Markers for Atrial Fibrillation WO 2016012783).

Figures

Figure 1
Figure 1
Change in the SF-12 physical and mental component scores according to the presence or absence of recurrent AT/AF. Shown in each box plot are the median changes with 25th and 75th percentiles in the SF-12 physical and mental component scores. The whiskers illustrate the maximum and minimum values. AF, atrial fibrillation; AT, atrial tachycardia.
Figure 2
Figure 2
Shown in the bar graph are the changes in Karnofsky score categories according to the presence or absence of recurrent AT/AF. *P value is for the comparison in the change in median Karnofsky scores from baseline to follow-up. AF, atrial fibrillation; AT, atrial tachycardia.
See this image and copyright information in PMC

Comment in

References

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