Quality of life improvement from thoracoscopic atrial fibrillation ablation in women versus men: a prospective cohort study.

ABSTRACT

OBJECTIVES: Thoracoscopic ablation has proven to be an effective and safe rhythm control strategy, especially for persistent atrial fibrillation. However, its impact on quality of life and potential gender differences remains unclear. METHODS: this prospective, single-centre observational study included consecutive patients with symptomatic atrial fibrillation undergoing thoracoscopic ablation. Quality of life was measured using the Short Form 36 (SF-36) and Atrial Fibrillation Effect on Quality-of-Life (AFEQT) questionnaires and longitudinal trend analysis including linear mixed models was used to assess gender-specific differences. RESULTS: 191 patients were included; mean age 63.9 ± 8.6 years, 61 (31.9%) women and 148 (77.5%) with non-paroxysmal atrial fibrillation. Women were older, more symptomatic and reported lower baseline quality of life. AFEQT summary scores substantially improved after three months (relative increase 51.5% from baseline; p < 0.001) and persisted up to 1-year (57.2%; p < 0.001). Women showed substantial quality of life improvement which was comparable to men at 1 year. Distinct gender-related trajectories for AFEQT were observed. Women showed more often clinically important decline over time, yet AF recurrence and age were predictive factors in both men and women. Patients with AF recurrence also experienced QoL improvements, albeit to a lesser extent than those in sinus rhythm (61.3% vs 26.9%, p < 0.001), with no differences between men and women. CONCLUSIONS: Thoracoscopic ablation for atrial fibrillation results in substantial quality of life improvement and was comparable for men and women. Understanding sex-specific and age-related trajectories is important to further enhance patient-centered atrial fibrillation care.