What question did this study set out to answer?

To assess changes in quality of life, cognitive function, and functional status based on arrhythmia recurrence following catheter ablation for atrial fibrillation.

October 12, 2020HeartOpen Access

Changes in quality of life, cognition and functional status following catheter ablation of atrial fibrillation

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Why the study?

It was unknown how quality of life, cognition, and functional status change according to arrhythmia recurrence after atrial fibrillation ablation.

Does freedom from recurrent AT/AF improve quality of life, cognition, and functional status in patients undergoing AF ablation?

Key Points

To assess changes in quality of life, cognitive function, and functional status based on arrhythmia recurrence following catheter ablation for atrial fibrillation.
Analyzed data from patients with versus without recurrent atrial tachycardia/atrial fibrillation within the AXAFA-AFNET 5 clinical trial.
Assessed outcomes using SF-12 physical and mental components, EQ-5D, Karnofsky functional status, and the Montreal Cognitive Assessment (MoCA <26 for mild cognitive impairment).
Calculated raw score changes and performed analysis of covariance (ANCOVA) to identify determinants of improvement post-ablation.
Patients without recurrent arrhythmia had more favorable unadjusted median changes in SF-12 physical (3 vs 1, p=0.026), SF-12 mental (2 vs 0, p=0.004), EQ-5D (0 vs 0, p=0.027), and Karnofsky status (10 vs 0, p=0.001).
In ANCOVA adjusting for baseline covariates, patients without recurrence maintained significantly greater improvements in Karnofsky functional status (p<0.001), but not SF-12 physical (p=0.238) or mental scores (p=0.065).
Across the overall cohort, the proportion of patients with at least mild cognitive impairment decreased from 30.3% (n=157) at baseline to 21.8% (n=113) at follow-up.

Structured PICO

Does freedom from recurrent AT/AF improve quality of life, cognition, and functional status in patients undergoing AF ablation?

Population

Patients with atrial fibrillation undergoing catheter ablation in the AXAFA-AFNET 5 clinical trial.

Intervention

No recurrent atrial tachycardia (AT)/atrial fibrillation (AF) after ablation

Comparator

Recurrent AT/AF after ablation

Outcome

Changes in quality of life (SF-12, EQ-5D), cognition (Montreal Cognitive Assessment), and functional status (Karnofsky)patient reported

Freedom from recurrent atrial arrhythmia after AF ablation is associated with greater improvements in functional status, though quality of life improvements appear similar regardless of recurrence.

Implication

Freedom from recurrence was associated with functional gains post-ablation; leaves open independent QoL effects and needs RCTs.

Abstract

OBJECTIVE: To investigate changes in quality of life (QoL), cognition and functional status according to arrhythmia recurrence after atrial fibrillation (AF) ablation. METHODS: We compared QoL, cognition and functional status in patients with recurrent atrial tachycardia (AT)/AF versus those without recurrent AT/AF in the AXAFA-AFNET 5 clinical trial. We also sought to identify factors associated with improvement in QoL and functional status following AF ablation by overall change scores with and without analysis of covariance (ANCOVA). RESULTS: -VASc scores (2.8 vs 2.3, p<0.001) and more persistent forms of AF (51 vs 39%, p=0.012). Median changes in the SF-12 physical (3 (25th, 75th: -1, 8) vs 1 (-5, 8), p=0.026) and mental scores (2 (-3, 9) vs 0 (-4, 5), p=0.004), EQ-5D (0 (0,2) vs 0 (-0.1, 0.1), p=0.027) and Karnofsky functional status scores (10 (0, 10) vs 0 (0, 10), p=0.001) were more favourable in patients without recurrent AT/AF. In the overall cohort, the proportion with at least mild cognitive impairment (Montreal Cognitive Assessment <26) declined from 30.3% (n=157) at baseline to 21.8% (n=113) at follow-up. ANCOVA identified greater improvement in Karnofsky functional status (p<0.001) but not SF-12 physical (p=0.238) or mental scores (p=0.065) in those without recurrent AT/AF compared with patients with recurrent AT/AF. CONCLUSIONS: Patients without recurrent AT/AF appear to experience greater improvement in functional status but similar QoL as those with recurrent AT/AF after AF ablation.