Quality of Life after Surgical Ablation of Persistent Atrial Fibrillation: A Prospective Evaluation

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• 作者：Alexander Chernyavskiy ; MD^a ; Yulia Kareva ; PhD^a ; ^{julia11108@mail.ru" class="auth_mail" title="E-mail the corresponding author} ; Inessa Pak ; PhD^a ; Sardor Rakhmonov^a ; Evgeny Pokushalov ; MD^b ; Alexander Romanov ; MD^b
• 关键词：Atrial fibrillation ; Quality of life ; Intraoperative radiofrequency ablation ; Implantable loop recorders.
• 刊名：Heart, Lung and Circulation
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：25
• 期：4
• 页码：378-383
• 全文大小：530 K

文摘

To compare the quality of life (QoL) of patients with persistent atrial fibrillation (AF) and ischaemic heart disease after modified mini-maze (MM) procedure or pulmonary vein isolation (PVI) using radiofrequency ablation (RFA) with patients in the control group (coronary artery bypass graft [CABG]) alone.

Methods

In this prospective randomised study, we included 95 patients with persistent AF and coronary heart disease who underwent open-heart surgery combined with intraoperative irrigated RFA (irrRFA). Patients were randomly assigned to three groups: CABG and PVI using irrRA (CABG+PVI, n=31), CABG and MM procedure using irrRA (CABG+MM, n=30), and isolated CABG (CABG alone, n=34). All patients received implantable loop recorders (ILRs). Patient QoL was assessed using the Short Form 36 (SF-36) preoperatively, and one and two years post-operatively. The study primary end point was freedom from AF one year after operation, measured by implantable loop recorders (ILRs); secondary endpoint included long-term clinical outcomes.

Results

No reoperations or hospital mortalities were recorded. Mean follow-up was 14.4±9.7 months. The percentages of patients free from AF determined by ILR were 80%, 86.2%, and 44.1% in the CABG+PVI, CABG+MM, and in the CABG alone groups, respectively. The QoL significantly improved in CABG+PVI and CABG+MM groups compared with CABG alone group in most domains.

Conclusion

Effective elimination of AF during CABG surgery improves QoL in all physical health domains of the SF-36 and the role-emotional functioning domain. Thus, patients with concomitant AF and coronary heart disease may benefit from intraoperative radiofrequency ablation to prevent relapse of the arrhythmia.