AF symptom improvement ‘reflects AF ablation efficacy’
MedWire News: Atrial fibrillation (AF) ablation yields sustained improvements in quality of life (QoL) at 2 years in patients with and without recurrence, report researchers whose study suggests that symptom relief more closely reflects ablative efficacy.
QoL measures showed a marked and sustained improvement across all ablative outcomes in most patients, but were not closely linked to overall ablative efficacy. By contrast, in a subgroup analysis, AF-specific symptom scores improved significantly more in patients with AF elimination free of antiarrhythmic drug (AAD) use than in those with AF controlled with AADs or in those with recurrent AF.
Douglas Packer and colleagues from the Mayo Clinic in Rochester, Minnesota, followed-up 502 symptomatic AF ablation recipients for recurrence, QoL, and AF symptoms.
“Although the primary goal of AF ablation is QoL improvement, this effect has yet to be demonstrated long term,” they explain. “Establishing that QoL benefit lasts beyond 1 year and is attributable to ablation-specific effects would justify the broader application of this expensive procedure with uncommon, but significant risks.”
Among 323 patients with 2 years of follow-up, 72% achieved AF elimination off AADs, 15% achieved AF control with AADs, and 13% had recurrent AF.
Post-ablation QoL improvements on the Short-Form 36 were observed in each group, both in terms of the Physical Component Summary (PCS) and Mental Component Summary (MCS) scores. There were no significant differences in improvements among the three ablative efficacy outcomes, with PCS improvements of 17.0, 13.2, and 12.3 and MCS improvements of 13.2, 13.1, and 9.7 in the AF elimination off AAD, AF control on AAD, and recurrent AF groups, respectively.
However, as reported in the Journal of the American College of Cardiology, changes in AF symptoms differed significantly among the three ablation efficacy outcomes (p=0.006). Among 103 patients who completed additional assessment by Mayo AF-Specific Symptom Inventories (MAFSI), those with AF elimination off AADs had a reduction of 9.5 points (on a score of 0 to 48), which was nearly significantly greater than the 5.6-point reduction (p=0.06) for patients with AF controlled with AADs (p=0.06), and significantly greater than the 3.4-point reduction (p=0.04) for those with recurrent AF.
In a related editorial, Eric Prystowsky and Benzy Padanilam from The Care Group in Indianapolis, Indiana, commented that improved QoL clearly does not necessarily mean all is well. “This means that we need to reassess either how we assess QoL measures or determine whether there are some unexplained mechanisms for symptom improvements with ablation of wide areas of left atrial tissue that do not correlate with AF recurrence,” they wrote.
The editorialists concluded: “We strongly suggest a better metric be developed, whether [the MAFSI] or a new one, before embarking on prospective studies aimed at defining AF therapies that improve QoL.”
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By Caroline Price