Hybrid ablation of atrial fibrillation improves patient quality of life: results from the AFEQT questionnaire

Background: The hybrid ablation (HA) strategy approach of combined off-pump epicardial surgical and endocardial catheter ablations for the treatment of atrial fibrillation (AF) is supported by randomized control studies demonstrating the improved efficacy of HA over isolated endocardial catheter ablation. Yet, the impact of HA for the treatment of AF on patient quality of life (QOL) is underreported. We herein report the effect of HA on patient QOL using a contemporary validated AF specific questionnaire. Methods: Retrospective review of patients who underwent a planned totally thoracoscopic HA approach and completed pre- and 12-month post Atrial Fibrillation Effect on QualiTy-of-life (AFEQT) questionnaires over a three-year period (2017–2019). Overall and subscale (symptoms, daily activities, treatment concerns, treatment satisfaction) AFEQT scores were analyzed. HA rhythm success was defined by standard Heart Rhythm Society (HRS) criteria [<30 seconds atrial fibrillation/atrial flutter/atrial tachycardia (AF/AFl/AT)] with or without class 1 or 3 anti-arrhythmia drug (AAD) via >24-hour Ziopatch or pacemaker evaluation at 12-month follow-up. Results: Seventy-four patient pre- and 12-month post AFEQT questionnaires were analyzed. Significant improvements in overall AFEQT score (45.1 vs. 87.6, P<0.0001) and each subscale AFEQT score—symptoms (57.7 vs. 91.4, P<0.0001), daily activities (38.8 vs. 84.9, P<0.0001), treatment concerns (26.6 vs. 86.0, P<0.0001) and treatment satisfaction (46.4 vs. 88.9, P<0.0001)—were observed. Twelve-month overall rhythm success (<30 seconds AF/AFl/AT with or without AAD) was 93% and HRS defined rhythm success was 76% (<30 seconds AF/AFl/AT without AAD). Three patients (4%) required new permanent pacemakers. No 30-day stroke or mortality occurred. Conclusions: AF patients treated with an HA approach experienced significantly improved QOL and a high rate of normal sinus rhythm restoration.