Catheter ablation did not significantly improve long-term health-related quality of life compared to antiarrhythmic drugs (median 79.2 vs 77 points; P=0.77), despite a greater reduction in AF burden.
RCT (n=149)
Does catheter ablation improve long-term health-related quality of life and reduce AF burden compared to antiarrhythmic drugs in patients with symptomatic atrial fibrillation?
Catheter ablation significantly reduces long-term AF burden compared to antiarrhythmic drugs, but this does not translate to a difference in long-term health-related quality of life, possibly due to high crossover rates.
Absolute Event Rate: 79.2% vs 77%
p-value: p=0.77
BACKGROUND: Data on long-term effects of catheter ablation vs antiarrhythmic drugs (AADs) on health-related quality of life (HRQoL) and atrial fibrillation (AF) burden are limited. OBJECTIVE: The study aimed to assess long-term HRQoL and rhythm data in patients with symptomatic AF. METHODS: The 75 patients who underwent ablation and 74 receiving AADs in the Catheter Ablation compared with Pharmacological Therapy for Atrial Fibrillation (CAPTAF) trial were followed for 48 months. The General Health subscale of the 36-Item Short-Form Health Survey, time to first AF episode ≥1 hour, and AF burden, recorded by implantable cardiac monitors, were compared. RESULTS: One hundred forty-seven patients completed follow-up, with 7 crossovers in the ablation group and 34 crossovers in the AAD group. General Health improved by ablation from a median of 62 points at baseline to 79.2 points at follow-up (P < .001) and by AADfrom a median of 67 to 77 points (P < .001), without treatment differences (P = .77). Time to first AF episode ≥1 hour was longer (median 257 days in the ablation group vs 180 days in the AAD group; P = .025). The cumulative AF burden during follow-up was lower in the ablation group (median 0.3%; interquartile range IQR 0%-1.4%) than in the AAD group (1.6%; IQR 0.1%-11.0%); P = .01. The cumulative reduction in AF burden compared with baseline was greater in the ablation group (median -89.5%; IQR -98.4% to -51.3%) than in the AAD group (-52.7%; IQR -92.6% to 263.6%); P < .001. CONCLUSION: HRQoL improvement in long-term did not differ between ablation and AAD groups despite a larger reduction in AF burden after ablation. The results should be interpreted in the light of a high crossover rate in the AAD group.
Wettervik et al. (Sat,) conducted a rct in Symptomatic atrial fibrillation (n=149). Catheter ablation vs. Antiarrhythmic drugs (AADs) was evaluated on General Health subscale of the 36-Item Short-Form Health Survey (p=0.77). Catheter ablation did not significantly improve long-term health-related quality of life compared to antiarrhythmic drugs (median 79.2 vs 77 points; P=0.77), despite a greater reduction in AF burden.