P1035Factors associated with quality-of-life improvement after catheter ablation of atrial fibrillation: insights from the Kansai Plus Atrial Fibrillation (KPAF) registry

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Kanda ◽  
M Masuda ◽  
S Shizuta ◽  
A Kobori ◽  
K Inoue ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Atrial Fibrillation ◽  
Heart Rate ◽  
Multivariate Analysis ◽  
Catheter Ablation ◽  
Left Atrial ◽  
Left Atrial Diameter ◽  
Factors Associated ◽  
Af Recurrence

Abstract Background Improving the quality of life (QoL) is one of the main purposes of catheter ablation (CA) of persistent atrial fibrillation (AF). Factors associated with QoL improvement after CA of AF patients have not been clarified. The Kansai Plus Atrial Fibrillation (KPAF) Registry is a multi-center registry enrolling more than 5,000 consecutive patients undergoing the first radiofrequency catheter ablation of AF. Purpose The aim of this study was to investigate the QoL change after AF ablation and its associated factors. Methods A total of 2030 patients in whom the QoL score was assessed before and one year after the ablation were enrolled from the KPAF registry (age 64±10 years, 75% male, paroxysmal 66%, CHADS2 score 1.1±1.1). The QoL was evaluated using the AF specific QoL evaluation method (AFQLQ), which scores the patient QoL within a range of 0–98 points. Results Overall, catheter ablation showed a significant increase in the AFQLQ score (68±19 vs. 86±13 points, P<0.01). AF recurrence was observed in 372 cases (18%) during a 1-year follow-up period. A multivariate analysis showed that AF recurrence, symptomatic AF, long AF duration, high preprocedural heart rate (>110 bpm) and small left atrial diameter were independent predictors of a QoL improvement defined as a >10% score increase. Multivariate analysis Conclusions CA of AF significantly improved the QoL. AF recurrence was one of the strong factors associated with QoL improvement. Symptomatic AF, long AF duration, high preprocedural heart rate and small left atrial diameter were independent predictors of QoL improvement.

scholarly journals Ablation Versus Drug Therapy for Atrial Fibrillation in Heart Failure: Results from the CABANA Trial

Circulation ◽  
2021 ◽  
Author(s):  
Douglas L. Packer ◽  
Jonathan P Piccini ◽  
Kristi H Monahan ◽  
Hussein R Al-Khalidi ◽  
Adam P Silverstein ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Drug Therapy ◽  
Catheter Ablation ◽  
Left Ventricular ◽  
Relative Reduction ◽  
Af Recurrence

Background: In patients with heart failure (HF) and atrial fibrillation (AF), several clinical trials have reported improved outcomes, including freedom from AF recurrence, quality of life (QOL), and survival, with catheter ablation. This report describes the treatment-related outcomes of the AF patients with HF enrolled in the Catheter Ablation vs Antiarrhythmic Drug Therapy for Atrial Fibrillation (CABANA) trial. Methods: CABANA randomized 2204 patients with AF who were ≥65 years old or <65 with ≥1 risk factor for stroke at 126 sites to ablation with pulmonary vein isolation or drug therapy including rate/rhythm control drugs. Of these, 778 (35%) had NYHA class ≥ II at baseline and form the subject of this report. The CABANA primary endpoint was a composite of death, disabling stroke, serious bleeding, or cardiac arrest. Results: Of the 778 HF patients enrolled in CABANA, 378 were assigned to ablation and 400 to drug therapy. Ejection fraction (EF) at baseline was available for 571 patients (73%) and 9.3% of these had an EF <40%, while 11.7% had EFs between 40-50%. In the intention-to-treat analysis, the ablation arm had a 36% relative reduction in the primary composite endpoint (hazard ratio [HR] 0.64; 95% confidence interval [CI], 0.41 to 0.99) and a 43% relative reduction in all-cause mortality (HR 0.57; 95% CI, 0.33 to 0.96) compared to drug therapy alone over a median follow-up of 48.5 months. AF recurrence was decreased with ablation (HR 0.56; 95% CI, 0.42 to 0.74). The adjusted mean difference for the AF Effect on QOL (AFEQT) summary score averaged over the entire 60-month follow-up was 5.0 points favoring the ablation arm (95% CI, 2.5 to 7.4 points), and the Mayo AF-specific Symptom Inventory (MAFSI) frequency score difference was -2.0 points favoring ablation (95% CI, -2.9 to -1.2). Conclusions: In patients with atrial fibrillation enrolled in CABANA who had clinically diagnosed stable heart failure at trial entry, catheter ablation produced clinically important improvements in survival, freedom from AF recurrence, and quality of life relative to drug therapy. These results, obtained in a cohort most of whom had preserved left ventricular function, require independent trial verification. Clinical Trial Registration: URL: https://www.clinicaltrials.gov Unique Identifier: NCT00911508

scholarly journals P6600Improvement in quality of life in patients that underwent catheter ablation for persistent atrial fibrillation

2018 ◽  
Vol 39 (suppl_1) ◽  
Author(s):  
K Nakajima ◽  
T Kimura ◽  
T Fujisawa ◽  
Y Katsumata ◽  
T Nishiyama ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Persistent Atrial Fibrillation

Abstract 15257: Epicardial and Peri-atrial Fat Attenuation Predict Recurrence in Patients Undergoing Repeat Catheter Ablation for Refractory Atrial Fibrillation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Mark S Brahier ◽  
Fengwei Zou ◽  
Frank Migliarese ◽  
Milos Tomovic ◽  
Alexandra Taylor ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Logistic Regression ◽  
Adipose Tissue ◽  
Catheter Ablation ◽  
Left Atrial ◽  
Left Atrial Volume ◽  
Epicardial Fat ◽  
Volume Index ◽  
Atrial Volume ◽  
Af Recurrence

Background: Identifying factors predictive of atrial fibrillation (AF) recurrence after catheter ablation (CA) can improve patient selection. It has been hypothesized that inflammatory paracrine signaling by metabolically active adipose tissue induces pathologic changes in surrounding cardiovascular tissue. In fact, fat attenuation on CT has been previously associated with AF recurrence after de novo CA. The purpose of this study was to investigate the predictive qualities of epicardial and peri-atrial adipose tissue in a population undergoing repeat CA. We hypothesized that higher epicardial and left peri-atrial fat attenuation would predict recurrence as markers of increased localized inflammation. Methods: The study population consisted of 84 patients with symptomatic, drug and ablation-refractory AF undergoing repeat CA. All patients had a pre-ablation, contrast-enhanced cardiac CT, which was analyzed for mean fat attenuation in Hounsfield units (HU) and left atrial volume using the post-processing program 3D Slicer. Patients were followed for recurrence of atrial tachyarrhythmias after a 3-month blanking period. We performed logistic regression to adjust for age, sex, BMI, hypertension, smoking history, diabetes, obstructive sleep apnea, and left atrial volume index. Results: Repeat CA patients with recurrence (n=52) had a higher epicardial fat attenuation (-84.8 ±5.6 vs -88.1 ±5.2 HU; p=0.009) and peri-atrial fat attenuation (-81.0 ±4.7 vs -83.2 ±4.3 HU; p=0.036) than those without recurrence (n=32) at a mean follow-up period of 26 ±18 months. Logistic regression analysis showed that epicardial fat attenuation (OR 1.21; p=0.005) and peri-atrial fat attenuation (OR 1.27; p=0.007) are predictive of AF recurrence independent of traditional risk factors. Conclusions: Epicardial and left peri-atrial adipose attenuation are predictive of recurrence in patients undergoing repeat CA for AF.

scholarly journals Clinically Meaningful Change in Quality of Life and Associated Factors Among Older Patients With Atrial Fibrillation

2020 ◽  
Vol 9 (18) ◽  
Author(s):  
Hawa O. Abu ◽  
Jane S. Saczynski ◽  
Jordy Mehawej ◽  
Mayra Tisminetzky ◽  
Catarina I. Kiefe ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Atrial Fibrillation ◽  
Older Patients ◽  
Logistic Models ◽  
Life Questionnaire ◽  
Meaningful Change ◽  
Patient Centered ◽  
Factors Associated ◽  
Fair Poor

Background Among older patients with atrial fibrillation, there are limited data examining clinically meaningful changes in quality of life (QoL). We examined the extent of, and factors associated with, clinically meaningful change in QoL over 1‐year among older adults with atrial fibrillation. Methods and Results Patients from cardiology, electrophysiology, and primary care clinics in Massachusetts and Georgia were enrolled in a cohort study (2015–2018). The Atrial Fibrillation Effect on Quality‐of‐Life questionnaire was used to assess overall QoL and across 3 subscales: symptoms, daily activities, and treatment concern. Clinically meaningful change in QoL (ie, difference between 1‐year and baseline QoL score) was categorized as either a decline (≤−5.0 points), no clinically meaningful change (−5.0 to +5.0 points), or an increase (≥+5.0 points). Ordinal logistic models were used to examine factors associated with QoL changes. Participants (n=1097) were on average 75 years old, 48% were women, and 87% White. Approximately 40% experienced a clinically meaningful increase in QoL and 1 in every 5 patients experienced a decline in QoL. After multivariable adjustment, women, non‐Whites, those who reported depressive and anxiety symptoms, fair/poor self‐rated health, low social support, heart failure, or diabetes mellitus experienced clinically meaningful declines in QoL. Conclusions These findings provide insights to the magnitude of, and factors associated with, clinically meaningful change in QoL among older patients with atrial fibrillation. Assessment of comorbidities and psychosocial factors may help identify patients at high risk for declining QoL and those who require additional surveillance to maximize important clinical and patient‐centered outcomes.

scholarly journals MediYoga as a part of a self-management programme among patients with paroxysmal atrial fibrillation – a randomised study

2019 ◽  
Vol 19 (1) ◽  
pp. 74-82 ◽  
Author(s):  
Maria Wahlström ◽  
Mårten Rosenqvist ◽  
Jörgen Medin ◽  
Ulla Walfridsson ◽  
Monica Rydell-Karlsson
Keyword(s):  
Quality Of Life ◽  
Atrial Fibrillation ◽  
Blood Pressure ◽  
Heart Rate ◽  
Paroxysmal Atrial Fibrillation ◽  
Control Group ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related

Background: Paroxysmal atrial fibrillation is associated with impaired health-related quality of life. Yoga has been suggested to improve health-related quality of life among patients with heart failure and hypertension. Aim: The aim of the study was to evaluate the effects of MediYoga, in respect of health-related quality of life, blood pressure, heart rate, as well as N-terminal pro b-type natriuretic peptide, among patients with symptomatic paroxysmal atrial fibrillation, compared with standard therapy or relaxation. Methods: Patients with symptomatic paroxysmal atrial fibrillation, n=132, were stratified for gender and randomised to MediYoga, a relaxation group or a control group, 44 patients per group with a 12-week follow-up. Health-related quality of life, blood pressure, heart rate and N-terminal pro b-type natriuretic peptide were assessed. Results: After 12 weeks, there were no differences in health-related quality of life between the groups. There were improvements in Short-Form Health Survey bodily pain, general health, social function, mental health and mental component summary scores within the MediYoga group ( p=0.014, p=0.037, p=0.029, p=0.030, p=0.019, respectively). No change was seen in the relaxation and control groups. Systolic blood pressure decreased in the MediYoga group (134±18 to 127±13) compared with the control group (126±17 to 127±15, p=0.041); no difference compared with the relaxation group (131±17 to 125±12). Diastolic blood pressure decreased in the MediYoga group (79±9 to 74 ±9) compared with the control group (76±9 to 79±8, p=0.005); no difference compared with the relaxation group (76±9 to 77±8). There were no differences in heart rate and N-terminal pro b-type natriuretic peptide between the groups after 12 weeks. Conclusions: MediYoga improves health-related quality of life and decreases blood pressure in patients with paroxysmal atrial fibrillation. MediYoga may be used as a part of a self-management programme among patients with paroxysmal atrial fibrillation.

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