Left atrial cryoablation added to mitral valve surgery did not improve the Physical Component Summary score at 12 months compared to surgery alone (mean 42.8 vs 44.0; P=0.700).
RCT (n=65)
Double-blind
Yes
Does epicardial left atrial cryoablation added to mitral valve surgery improve quality of life in patients with permanent atrial fibrillation?
Adding left atrial cryoablation to mitral valve surgery does not improve health-related quality of life in patients with permanent atrial fibrillation.
Absolute Event Rate: 42.8% vs 44%
p-value: p=0.700
Aims: Concomitant surgical ablation of atrial fibrillation (AF) in patients undergoing mitral valve surgery (MVS) has almost become routine despite lack of convincing information about improved quality-of-life (QOL) and clinical benefit. Quality-of-life was therefore assessed after MVS with or without epicardial left atrial cryoablation. Methods and results: Sixty-five patients with permanent AF randomized to MVS with or without left atrial cryoablation, in the double-blinded multicentre SWEDMAF trial, replied to the Short Form 36 QOL survey at 6 and 12 months follow-up. The QOL scores at 12 month follow-up did not differ significantly between patients undergoing MVS combined with cryoablation vs. those undergoing MVS alone regarding Physical Component Summary mean 42.8 (95% confidence interval 38.3-47.3) vs. mean 44.0 (40.1-47.7), P = 0.700 or Mental Component Summary mean 53.1 (49.7-56.4) vs. mean 48.4 (44.6-52.2), P = 0.075. All patients, irrespective of allocated procedure, reached the same QOL after surgery as an age-matched Swedish general population. The Physical Component Summary in patients with sinus rhythm did also not differ from those in AF at 12 months; mean 45.4 (42.0-48.7) vs. mean 40.5 (35.5-45.6), P = 0.096) nor was there a difference in Mental Component Summary; mean 51.0 (48.0-54.1) vs. mean 49.6 (44.6-54.5), P = 0.581). Conclusion: Left atrial cryoablation added to MVS does not improve health-related QOL in patients with permanent AF, a finding that raises concerns regarding recommendations made for this combined procedure.
Bagge et al. (Sat,) conducted a rct in Permanent atrial fibrillation in patients undergoing mitral valve surgery (n=65). Epicardial left atrial cryoablation combined with mitral valve surgery vs. Mitral valve surgery alone was evaluated on Physical Component Summary score at 12 months (p=0.700). Left atrial cryoablation added to mitral valve surgery did not improve the Physical Component Summary score at 12 months compared to surgery alone (mean 42.8 vs 44.0; P=0.700).