P4597Health-related quality of life change after thoracoscopic surgery for advanced atrial fibrillation: results of the AFACT study

Introduction: The AFACT study (NCT 01091389) assessed the efficacy and safety of ganglion plexus (GP) ablation in patients with symptomatic advanced atrial fibrillation (AF) undergoing thoracoscopic surgical ablation. Change in quality of life (QoL) was a predefined secondary outcome. Purpose: We evaluated health-related QoL at 6 and 12 months after thoracoscopic surgical ablation. Methods: Patients (n=240) underwent thoracoscopic pulmonary vein isolation, with additional left atrial lines in patients with persistent AF. Patients were randomized to additional GP ablation or control. Patients were followed up systematically with ECG and 24-hour Holter monitoring every 3 months, and when symptoms were reported, up to 12 months. Short form 36 (SF-36) QoL questionnaires were collected at baseline, at 6 and 12 months of follow-up. SF-36 scores from the general Dutch population were used as reference scores. Results: Two-hundred-one patients were eligible for QoL analysis (age 59±8 years, 72% men, 68% enlarged left atrium, 57% persistent AF). Patients improved in physical and mental health at 6 (both p<0.01) and 12 months (both p<0.01) relative to baseline, with no difference between the GP (n=101) or control (n=100) groups. SF-36 subscores in patients with one or no AF recurrences were similar to those in the general Dutch population after 12 months. Patients with multiple AF recurrences (30%) improved in mental (p<0.01), but not physical health, and 6/8 SF-36 subscales remained below the general Dutch population. Thirty-one patients (15%) had major adverse events, of which 10 were irreversible. Patients with irreversible adverse events had persistently diminished QoL scores at 12 months.