Effects of integrated lifestyle management before pulmonary vein isolation on quality of life – results from the POP-AF RCT

Background Atrial fibrillation (AF) is a lifestyle-related cardiac arrhytmia, with modifiable risk factors negatively affecting treatment outcomes. A cornerstone of AF treatment is catheter ablation. Previously reported results from the POP-AF randomized controlled trial (RCT) demonstrated that nurse-led integrated lifestyle management improves outcomes of AF ablation by reducing the need for repeat ablation and cardioversion. Purpose The aim of the current study was to determine the effect of integated lifestyle management on quality of life in AF ablation patients. Methods The POP-AF RCT involved patients referred for their first catheter ablation due to symptomatic paroxysmal or persistent AF. Patients had at least one of the following modifiable risk factors: body mass index ≥27 kg/m2, LDL cholesterol >2.6 mmol/L or total cholesterol >5.0 mmol/L, hypertension, diabetes mellitus with HbA1c ≥53 mmol/mol, active smoking, or alcohol intake >14 equivalent units per week. Patients were randomized 1:1 to receive integerated nurse-led care or standard care. All patients underwent pulmonary vein isolation with pulsed field ablation. Quality of life was assessed at baseline, 3 months after ablation, and 12 months after ablation using digital questionnaires. The AF-specific Atrial Fibrillation Effect on Quality of Life (AFEQT) questionnaire was used to assess AF-specific quality of life. Additionally, the Treatment Burden Questionnaire (TBQ) was used to assess the burden experienced by patients throughout the lifestyle modification process. TBQ scores of ≥59 indicate a risk of patients becoming overwhelmed by medical care. Results From 2021 to 2024, a total of 145 participants were included in the trial. Seventy-four percent were male with a median age of 62 years. At baseline, both treatment groups had comparable AFEQT scores (56.5 in the intervention group and 57.4 in the control group; p = 0.987). At 3 months post-ablation, both groups showed a significant increase in AFEQT (p <0.001), with the intervention group reporting a higher sore (88.9 versus 80.6; p = 0.026). At 12 months post-ablation, the difference between treatment groups diminished due to a further increase in quality of life in the control group (Figure 1). TBQ scores did not differ significantly between the two groups at any time during the trial, nor did the proportion of patients who felt overwhelmed (Figure 2). Conclusions Nurse-led integrated lifestyle management improves AF ablation outcomes. This study further demonstrated that patients undergoing lifestyle treatment had better AF-specific quality of life at 3 months post-ablation compared to the control group. At 12 months, this difference diminished, possibly due to the control group receiving more repeat ablations. Interestingly, patients undergoing elaborate lifestyle management did not report a higher treatment burden or greater feeling of being overwhelmed than those in the control group.Figure 1.Median AFEQT scoresFigure 2.Median TBQ scores