Key result
Stand-alone and concomitant arrhythmia surgery for atrial fibrillation improved quality of life at 1 year, with improvements related to the maintenance of sinus rhythm.
Why the study?
Studies specifically evaluating the effect of arrhythmia surgery on patient-reported quality of life are scarce.
Does stand-alone or concomitant arrhythmia surgery improve patient-reported quality of life in patients with atrial fibrillation?
Meta-Analysis
Does stand-alone or concomitant arrhythmia surgery improve patient-reported quality of life in patients with atrial fibrillation?
Arrhythmia surgery for atrial fibrillation improves quality of life at 1 year, with the greatest benefit observed in patients who successfully maintain sinus rhythm.
Supports surgical ablation for AF to improve quality of life; confirms sinus rhythm maintenance drives the benefit.
OBJECTIVES: Patient-reported quality of life (QOL) has become an important endpoint for arrhythmia surgery for atrial fibrillation (AF). While studies specifically evaluating the effect of arrhythmia surgery on QOL are scarce, we aimed to summarize current evidence of QOL following concomitant and stand-alone arrhythmia surgery for AF. METHODS: All studies reporting on QOL using questionnaires from patients undergoing arrhythmia surgery for AF, both stand-alone and concomitant, were included in this systematic review. A meta-analysis was performed on inter-study heterogeneity of changes in QOL on 9 of 12 included studies that used the Short-Form 36 tool and meta-regression based on rhythm outcome after 1 year was executed. Finally, differences in QOL following stand-alone arrhythmia surgery and concomitant procedures were evaluated. RESULTS: Overall, QOL scores improved 1 year after surgical ablation for AF evaluated by several questionnaires. In stand-alone arrhythmia procedures, meta-regression showed significant improvements in those who were in sinus rhythm compared to those in AF after 1 year. This association between an improved QOL and the procedural effectiveness was also suggested in concomitant procedures. However, when comparing QOL of patients undergoing cardiac surgery with and without add-on surgical ablation for AF, only the variable 'physical role' demonstrated a significant improvement. CONCLUSIONS: In patients with AF, QOL improves after both stand-alone and concomitant arrhythmia surgery. In the concomitant group, this improvement can be attributed to both the cardiac procedure itself as well as the add-on arrhythmia surgery. However, both in stand-alone and concomitant procedures, the improvement in QOL seems to be related to the effectiveness of the procedure to maintain sinus rhythm after 12 months.
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Maesen et al. (2021) conducted a meta-analysis in Atrial fibrillation. Arrhythmia surgery (stand-alone and concomitant) vs. Cardiac surgery without add-on surgical ablation / atrial fibrillation rhythm was evaluated on Change in quality of life (QOL). Stand-alone and concomitant arrhythmia surgery for atrial fibrillation improved quality of life at 1 year, with improvements related to the maintenance of sinus rhythm.
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