Quality of life before and after catheter ablation (pulmonary vein isolation) for atrial fibrillation: Results from the Netherlands Heart Registration

BACKGROUND: Reducing AF-related symptoms and improving health-related quality of life (HRQoL) are important drivers in the decision for pulmonary vein isolation (PVI) in treating symptomatic atrial fibrillation (AF). We assessed the association between various patient characteristics, intervention, and outcome variables, and HRQoL both prior to and one year after PVI, with specific attention to groups that did not improve or were still impaired in HRQoL post PVI. METHODS: Observational, retrospective multicenter cohort study within 8 hospitals participating in the Netherlands Heart Registration (NHR). Patients who underwent PVI between 2016 and 2019 and completed the Atrial Fibrillation Effect on Quality-of-Life (AFEQT) questionnaire both prior to and one year after were included. Accepted cut-off values for impaired HRQoL and clinically important difference (CID) were used. RESULTS: Mean AFEQT score (n = 2,534) was 55.6 ± 19.7 prior to intervention and 79.8 ± 20.2 after. Post-PVI, 39.5% of the population was still impaired in HRQoL (< 80 points), and 19.2% failed to achieve CID (delta ≥ 5 points). Lower baseline AFEQT-score (odds ratio [OR], 0.96 [per 1‑point increase]; 95% CI, 0.96-0.97; p < 0.001) and female sex (odds ratio [OR], 1.42; 95% CI, 1.16-1.75; p < 0.001) were the most prominent related factors with impaired HRQoL post-PVI. Higher baseline AFEQT-score (odds ratio [OR], 1.04 [per 1‑point increase]; 95% CI, 1.04-1.05; p < 0.001) was strongly associated with failure to achieve CID. CONCLUSION: Despite a major increase in HRQoL across the population, over one-third of patients were still impaired in HRQoL post-PVI. Multiple factors were identified that may guide counselling of AF patients about treatment choice.