Logo: to the web site of Uppsala University

uu.sePublications from Uppsala University
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
The results of health-related quality of life assessment depend on the prevailing rhythm at the assessment: Experience from the CAPTAF trial (Catheter Ablation Compared with Pharmacological Therapy for Atrial Fibrillation)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.ORCID iD: 0000-0002-0305-8043
Show others and affiliations
2021 (English)In: Cardiovascular Electrophysiology, ISSN 1045-3873, E-ISSN 1540-8167, Vol. 32, no 8, p. 2159-2164Article in journal (Refereed) Published
Abstract [en]

AIMS: To assess whether the prevailing rhythm at the time of replying to symptom and health-related quality of life (HR-QoL) questionnaires impacts the findings.

METHOD: A total of 150 patients from the randomized Catheter Ablation Compared with Pharmacological Therapy for Atrial Fibrillation-trial, comparing atrial fibrillation (AF) ablation versus drugs, were included. The effect of the prevailing rhythm on the outcome results of the HR-QoL 36-Item Short-Form Health Survey, the symptom severity questionnaire (SSQ), and the European Heart Rhythm Association (EHRA) score for classification of AF-related symptoms was assessed.

RESULTS: AF as the prevailing rhythm was independently associated with a significantly lower Vitality score; 18.4 points lower (95% confidence interval -32.7 to -4.1, p = .01) compared with sinus rhythm when adjusted for AF burden, median duration of episode, number of episodes, beta-blocker use, type of AF, and sex. The presence of AF did not affect the General Health score compared with sinus rhythm, nor did it influence symptoms assessed by the SSQ or EHRA score.

CONCLUSION: The observation that the presence of AF versus sinus rhythm when conducting HR-QoL tests had a negative impact on its outcome, leaving symptom-related questionnaires unaffected, implies that the prevailing rhythm should be taken into account when results of HR-QoL questionnaires are interpreted.

Place, publisher, year, edition, pages
John Wiley & Sons, 2021. Vol. 32, no 8, p. 2159-2164
Keywords [en]
atrial fibrillation, health-related quality of life, implantable loop recorders, rhythm
National Category
Cardiac and Cardiovascular Systems
Research subject
Cardiology
Identifiers
URN: urn:nbn:se:uu:diva-451796DOI: 10.1111/jce.15147ISI: 000671864200001PubMedID: 34223671OAI: oai:DiVA.org:uu-451796DiVA, id: diva2:1589057
Funder
Swedish Research Council, 2014-36708-117759-70Swedish Heart Lung Foundation, 20150751Medtronic, Sweden, 1787Available from: 2021-08-30 Created: 2021-08-30 Last updated: 2024-01-15Bibliographically 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)
Opponent
Supervisors
Available from: 2023-08-23 Created: 2023-07-28 Last updated: 2023-08-23

Open Access in DiVA

fulltext(217 kB)137 downloads
File information
File name FULLTEXT01.pdfFile size 217 kBChecksum SHA-512
b618e948ef29c1962c37e5371927af644a8c8afed73716f90f12293d894547b09cfc51a8ca2dc28df7144eec8350e52cc3a64326ddb1a349d18961743add9d06
Type fulltextMimetype application/pdf

Other links

Publisher's full textPubMed

Authority records

Jansson, VictoriaSciaraffia, ElenaBlomström-Lundqvist, Carina

Search in DiVA

By author/editor
Jansson, VictoriaSciaraffia, ElenaBlomström-Lundqvist, Carina
By organisation
Cardiology-ArrhythmiaCardiology
In the same journal
Cardiovascular Electrophysiology
Cardiac and Cardiovascular Systems

Search outside of DiVA

GoogleGoogle Scholar
Total: 137 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

doi
pubmed
urn-nbn

Altmetric score

doi
pubmed
urn-nbn
Total: 83 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf