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Atrial fibrillation burden, episode duration and frequency in relation to quality of life in patients with implantable cardiac monitor
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.ORCID iD: 0000-0002-0305-8043
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2021 (English)In: IJC Heart & Vasculature, E-ISSN 2352-9067, Vol. 34, article id 100791Article in journal (Refereed) Published
Abstract [en]

Aims: To assess the relation between atrial fibrillation (AF) characteristics and health-related quality of life (QoL), and which AF characteristic had the greatest impact.

Method: The AF characteristics burden (percentage of time in AF), duration and number of AF episodes/month were obtained from implantable cardiac monitors during the 2-month run-in period in 150 patients included in the randomized CAPTAF trial comparing early ablation and antiarrhythmic drug therapy. The QoL was measured by the General Health and Vitality dimensions of the 36-Item Short-Form Health Survey. AF characteristics were analysed continuously and in quartiles (Q1-Q4).

Results: Greater AF burden (p = 0.003) and longer AF episodes (p = 0.013) were associated with impaired QoL (Vitality score only) in simple linear regression analyses. Greater AF burden was, however, the only AF characteristic associated with lower QoL, when adjusted for sex, type of AF, hypertension, heart rate above 110 beats per minute during AF, and beta-blocker use in multiple linear regression analyses. For every 10% increase in AF burden there was a 1.34-point decrease of Vitality score (95% confidence interval (CI) -2.67 to -0.02, p = 0.047). The Vitality score was 12 points lower (95% CI -22.73 to -1.27, p = 0.03) in patients with an AF burden > 33% (Q4) versus those with < 0.45% (Q1), but only in unadjusted analysis.

Conclusion: AF burden had a greater impact on QoL (Vitality), than the duration and number of AF episodes, corroborating that AF burden may be the preferred outcome measure of rhythm control in trials including relatively healthy AF populations.

Place, publisher, year, edition, pages
2021. Vol. 34, article id 100791
Keywords [en]
Atrial fibrillation, Atrial fibrillation burden, Health-related quality of life, Implantable cardiac monitor, Loop recorder, Randomized
National Category
Cardiac and Cardiovascular Systems
Research subject
Cardiology
Identifiers
URN: urn:nbn:se:uu:diva-444462DOI: 10.1016/j.ijcha.2021.100791ISI: 000667480400024PubMedID: 34036145OAI: oai:DiVA.org:uu-444462DiVA, id: diva2:1561607
Funder
Swedish Heart Lung Foundation, 20150751Swedish Research Council, 2014-36708-117759-70Erik, Karin och Gösta Selanders FoundationMedtronic, SwedenAvailable from: 2021-06-07 Created: 2021-06-07 Last updated: 2023-07-28Bibliographically approved
In thesis
1. Catheter ablation compared to antiarrhythmic drugs in patients with atrial fibrillation: A study focusing on arrhythmic burden and quality of life
Open this publication in new window or tab >>Catheter ablation compared to antiarrhythmic drugs in patients with atrial fibrillation: A study focusing on arrhythmic burden and quality of life
2023 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Patients with atrial fibrillation (AF) experience symptoms and have impaired health-related quality of life (HRQoL). Rhythm control therapy, including antiarrhythmic drugs (AAD) and catheter ablation for pulmonary vein isolation, aims to relieve symptoms and improve HRQoL. 

This thesis aimed to study HRQoL and rhythm outcomes after rhythm control therapy and to explore the relationship between symptoms, HRQoL, and AF. 

In the short-term 12-month follow-up study after cryoballoon catheter ablation, patients with persistent and paroxysmal AF had a similar symptom burden and HRQoL at follow-up. However, freedom from AF recurrence was lower in patients with persistent AF (64.9%) than paroxysmal AF (82.2%). 

In the long-term 48-month follow-up study, patients assigned to AADs and catheter ablation for pulmonary vein isolation improved their HRQoL compared to before treatment, without differences in improvement between the groups. Patients in the ablation group had a higher reduction in AF burden than the AAD group (-91.4% versus -52.7%) and a longer time to first AF recurrence of ≥1 hour (median 257 versus 180 days). The AAD group had a four times higher crossover rate than the AAD group. 

Atrial fibrillation burden (percentage of time in AF) had the greatest impact on HRQoL, as opposed to the duration and frequency of AF episodes. In addition, if AF was the prevailing rhythm when assessing HRQoL with generic questionnaires, the HRQoL was lower than in those with sinus rhythm. However, the prevailing rhythm did not influence the symptom assessment. 

In conclusion, regardless of the type of AF, patients presented similar short-term symptoms and HRQoL after cryoballoon ablation, although patients with persistent AF had worse rhythm outcomes. Even though the long-term rhythm outcomes were better in the ablation group, HRQoL improvements did not differ between catheter ablation and AAD. This was probably explained by crossover. The prevailing rhythm should be considered when interpreting results from generic HRQoL questionnaires to ensure more accurate results. Furthermore, the results indicate that the AF burden reflects HRQoL the most, as opposed to the duration and frequency of AF episodes. AF burden may therefore be the preferred rhythm outcome measure in future trials of rhythm control.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2023. p. 77
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1959
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-508241 (URN)978-91-513-1851-6 (ISBN)
Public defence
2023-09-15, Ebba Enghoffsalen, Uppsala University Hospital, Entrance 50, Uppsala, 13:00 (English)
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Supervisors
Available from: 2023-08-23 Created: 2023-07-28 Last updated: 2023-08-23

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Jansson, VictoriaSciaraffia, ElenaBlomström-Lundqvist, Carina

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