Atrial Fibrillation Catheter Ablation vs Medical Therapy and Psychological Distress: A Randomized Clinical Trial.

Importance: The impact of atrial fibrillation (AF) catheter ablation on mental health outcomes is not well understood. Objective: To determine whether AF catheter ablation is associated with greater improvements in markers of psychological distress compared with medical therapy alone. Design, Setting, and Participants: The Randomized Evaluation of the Impact of Catheter Ablation on Psychological Distress in Atrial Fibrillation (REMEDIAL) study was a randomized trial of symptomatic participants conducted in 2 AF centers in Australia between June 2018 and March 2021. Interventions: Participants were randomized to receive AF catheter ablation (n = 52) or medical therapy (n = 48). Main Outcomes and Measures: The primary outcome was Hospital Anxiety and Depression Scale (HADS) score at 12 months. Secondary outcomes included follow-up assessments of prevalence of severe psychological distress (HADS score >15), anxiety HADS score, depression HADS score, and Beck Depression Inventory-II (BDI-II) score. Arrhythmia recurrence and AF burden data were also analyzed. Results: A total of 100 participants were randomized (mean age, 59 [12] years; 31 [32%] women; 54% with paroxysmal AF). Successful pulmonary vein isolation was achieved in all participants in the ablation group. The combined HADS score was lower in the ablation group vs the medical group at 6 months (8.2 [5.4] vs 11.9 [7.2]; P = .006) and at 12 months (7.6 [5.3] vs 11.8 [8.6]; between-group difference, -4.17 [95% CI, -7.04 to -1.31]; P = .005). Similarly, the prevalence of severe psychological distress was lower in the ablation group vs the medical therapy group at 6 months (14.2% vs 34%; P = .02) and at 12 months (10.2% vs 31.9%; P = .01), as was the anxiety HADS score at 6 months (4.7 [3.2] vs 6.4 [3.9]; P = .02) and 12 months (4.5 [3.3] vs 6.6 [4.8]; P = .02); the depression HADS score at 3 months (3.7 [2.6] vs 5.2 [4.0]; P = .047), 6 months (3.4 [2.7] vs 5.5 [3.9]; P = .004), and 12 months (3.1 [2.6] vs 5.2 [3.9]; P = .004); and the BDI-II score at 6 months (7.2 [6.1] vs 11.5 [9.0]; P = .01) and 12 months (6.6 [7.2] vs 10.9 [8.2]; P = .01). The median (IQR) AF burden in the ablation group was lower than in the medical therapy group (0% [0%-3.22%] vs 15.5% [1.0%-45.9%]; P < .001). Conclusion and Relevance: In this trial of participants with symptomatic AF, improvement in psychological symptoms of anxiety and depression was observed with catheter ablation, but not medical therapy. Trial Registration: ANZCTR Identifier: ACTRN12618000062224.

Association Between Quality of Life and Procedural Outcome After Catheter Ablation for Atrial Fibrillation: A Secondary Analysis of a Randomized Clinical Trial.

Importance: Catheter ablation is effective in reducing atrial fibrillation (AF), but the association of ablation for AF with quality of life is unclear. Objective: To evaluate whether the procedural outcome of ablation for AF is associated with quality of life (QOL) measures. Design, Setting, and Participants: This was a prespecified secondary analysis of the Substrate and Trigger Ablation for Reduction of Atrial Fibrillation-Part II (STAR AF II) prospective randomized clinical trial, which compared 3 strategies for ablation of persistent AF. This analysis included 549 of the 589 patients enrolled in the trial who underwent ablation. Enrollment occurred at 35 centers in Europe, Canada, Australia, China, and Korea from November 2010 to July 2012. Data for the current study were analyzed on December 11, 2019. Interventions: Patients underwent AF ablation with 1 of 3 ablation strategies: (1) pulmonary vein isolation (PVI), (2) PVI plus complex fractionated electrograms, or (3) PVI plus linear lesions. Main Outcomes and Measures: Quality of life was assessed at baseline and at 6, 12, and 18 months after ablation for AF using the 36-Item Short Form Health Survey and the EuroQol Health-Related Quality of Life 5-Dimension 3-Level questionnaire. Scores were also converted to a physical health component score (PCS) and a mental health component score (MCS). Individual AF burden was calculated by the total time with AF from Holter monitors and the percentage of transtelephonic monitor recordings showing AF. Results: Among the 549 patients included in this secondary analysis, QOL was assessed in 466 (85%) at baseline and at 6, 12, and 18 months after ablation for AF. The mean (SD) age of the study population was 60 (9) years; 434 (79%) individuals were men, and 417 (76%) had continuous AF for 6 months or more before ablation. The AF burden significantly decreased from a mean (SD) of 82% (36%) before ablation to 6.6% (23%) after ablation (P < .001). Significant improvements in mean (SD) PCS (68.3 [20.7] to 82.5 [18.6]) and MCS (35.3 [8.6] to 37.5 [7.6]) occurred 18 months after ablation (P < .05 for both). Significant QOL improvement occurred in all 3 study arms and regardless of AF recurrence, defined as AF episodes lasting more than 30 seconds: for no recurrence, mean (SD) PCS increased from 66.5 (20.9) to 79.1 (19.4) and MCS from 35.3 (8.7) to 37.7 (7.7); for recurrence, mean (SD) PCS increased from 70.2 (20.4) to 86.4 (16.8) and MCS from 35.3 (8.6) to 37.1 (7.4) (P < .05 for all). When outcome was defined by AF burden reduction, in patients with less than 70% reduction in AF burden, the increase in PCS was significantly less than in those with greater than 70% reduction, and only 3 of 8 subscales showed significant improvement. Conclusions and Relevance: In this secondary analysis, decreases in AF burden after ablation for AF were significantly associated with improvements in QOL. Quality of life changes were significantly associated with the percentage of AF burden reduction after ablation. Trial Registration: ClinicalTrials.gov Identifier: NCT01203748.

Lifestyle interventions after ablation for atrial fibrillation: a systematic review.

BACKGROUND: Risk factors of atrial fibrillation include diabetes, obesity and physical inactivity. Positive effects such as decreased atrial fibrillation burden have been reported for atrial fibrillation patients who have participated in lifestyle changing interventions after atrial fibrillation ablation treatment. AIM: The aim of this study was to assess the evidence on the benefits and harms of lifestyle and risk factor management interventions in patients undergoing atrial fibrillation ablation. METHOD: Our systematic review searched MEDLINE, EMBASE, CINAHL, Psychinfo, Web of Science and CENTRAL using key terms related to atrial fibrillation and lifestyle, including interventional trials. The primary outcomes were mortality and serious adverse events. Random effects meta-analyses of outcomes were conducted when appropriate. RESULTS: Two randomised controlled trials and two non-randomised interventional trials with a total of 498 patients were included. Six primary events were reported for the intervention groups and five events for the control groups (relative risk of 1.03, 95% confidence interval (CI) 0.3 to 3.1, I2 0%, P = 0.537). Effects in favour of the intervention groups were found for atrial fibrillation frequency (0.82 points, 95% CI -1.60 to -0.03, I2 87.3%, P = 0.005), atrial fibrillation duration (-0.76 points, 95% CI -1.64 to 0.12, I2 89.1%, P = 0.002) and body mass index (-5.40 kg/m2, 95% CI 6.22 to -2.57, I2 83.9%, P = 0.013). Risk of bias in the four studies was judged to be low to moderate. CONCLUSION: Lifestyle changing interventions seem to have a positive effect on outcomes relevant to patients undergoing atrial fibrillation ablation, but the included studies were small, interventions were inhomogeneous, and the quality of evidence was low to moderate. More studies are warranted.

Patients' experiences 1-6 months after atrial fibrillation ablation: An holistic perspective.

AIM: To describe patients' experiences from a holistic perspective 1-6 months after atrial fibrillation (AF) ablation. BACKGROUND: Catheter ablation (CA) is an invasive treatment for AF. While CA has Class 1A indication, the latest guidelines for AF management state there is an urgent need to better understand complications in clinical practice to improve the quality of AF ablation procedures. DESIGN: A qualitative analytic approach based on a deductive and descriptive design was used. METHODS: Interviews of 19 patients, carried out from September 2016 to February 2017, were analysed using qualitative content analysis. FINDINGS: Five themes were identified; one in each life dimension due to the deductive design based on a holistic model: (a) having unexpected complications with a slower recovery; (b) discovering one's own self-management strategies when lacking information and insufficient follow-up; (c) managing resentment through different coping strategies while emotional reactions depended on feeling better or worse; (d) failing to receive full understanding and support from close ones, with social consequences when the biophysical level did not return to normal; (e) gradually adopting new life perspectives with a hope for a better future, despite having unmet expectations and uncertainty, leading to discovering existential matters. CONCLUSION: Patients' post CA experiences could be understood in terms of a holistic model. Their feelings of uncertainty caused by a lack of medical follow-up led to emotional reactions, the magnitude of which depended on feeling-well or worse. Patients' need more information about possible complications, suggesting follow-up and patient education needs improvement.

Understanding how patients use visualization during ablation of atrial fibrillation in reducing their experience of pain, anxiety, consumption of pain medication and procedure length: Integrating quantitative and qualitative results.

BACKGROUND: Patients who undergo radiofrequency ablation of atrial fibrillation with a light conscious sedation often feel pain during the procedure which can be difficult to relieve with pharmacological pain treatment alone. In a quasi-experimental study, it was found that visualization together with usual pain medication reduced the amount of analgesics used. In addition, patients spontaneously expressed pain significantly fewer times outside the scheduled measurements. No difference was found in the perception of pain intensity or anxiety and procedure length in the study. In a subsequent qualitative study with patients from the intervention group in the quantitative study, patients reported visualization as a positive experience which helped them manage pain and anxiety by supporting their individual strategies and without inconvenience. AIM: To examine patients' experiences with the effect of visualization during ablation of atrial fibrillation and its association with pain intensity, anxiety, pain medication and procedure length. METHODS: A mixed-method study with explanatory sequential design including a quasi-experimental study with a control and an intervention group and a qualitative interview study with semi-structured interviews. The results from the two studies in the mixed method study have been integrated by merging and constructing follow-up joint displays. RESULTS: Three themes were identified from the integration of the results from the quantitative and qualitative studies when analyzing and interpreting the results: "Zero pain is not always the goal"; "Not a real procedure time reduction but a sense of time shrinkage" and "Importance of the nurse's presence, visualization or not". CONCLUSION: Visualization can help patients to manage procedural pain when going through ablation of atrial fibrillation but the effect of an intervention such as visualization cannot be measured by pain intensity because the effect of visualization helps patients to cope with the pain and not to reduce the experience of pain intensity. It was shown that the patients had a feeling of reduced procedure time, although it was not reduced statistically significantly by using visualization. Finally, patients did not feel high anxiety during the procedure which was in line with very low values of anxiety measured in the quantitative study but at the same time the presence of the staff was of great importance to them in providing a feeling of security. A reduction of analgesics as found in the study is not only a matter of safety, it is also important in the patient's perception.

'It's like a frog leaping about in your chest': Illness and treatment perceptions in persistent atrial fibrillation.

OBJECTIVES: Persistent atrial fibrillation (AF) is an abnormal heart rhythm associated with low quality of life (QoL) and significant health-related costs. The purpose of the study was to examine patients' illness and treatment beliefs and ways of coping with AF symptoms, to provide insight into promoting better QoL and treatment-specific management. DESIGN: Beliefs were explored across three procedural treatment groups using a qualitative cross-sectional design. METHODS: Thirty semi-structured interviews were carried out with patients undertaking cardioversion (n = 10), catheter ablation (n = 11) and atrioventricular node ablation (n = 9). Interviews were transcribed and analysed using inductive thematic analysis with elements of grounded theory. RESULTS: An overarching theme of a vicious cycle was evident, which related to perceived lack of knowledge and understanding of AF, attempts to control symptoms and negative emotional reactions to failed control attempts. This vicious cycle related to three subordinate themes: (1) unpredictability and uncertainty of AF and symptoms; (2) coping with symptoms through (a) avoidance (b) all-or-nothing- (c) slowing down behaviours; and (3) concerns and expectations about treatment. CONCLUSIONS: Patients outlined a need to gain control of unpredictable symptoms by monitoring and varying activity levels. These behaviours were often appraised as ineffective at controlling symptoms, leading to heightened uncertainty and increased activity avoidance. Treatment concerns escalated with increasing number and invasiveness of procedures. Improving AF patients' perceived understanding of their illness and treatment and promoting more effective symptom-management strategies may alleviate psychological distress and improve QoL. Themes elaborated on the common-sense model whereby patients' beliefs about illness and treatment interact with coping behaviours. Statement of contribution What is already known about this subject? Quality of life (QoL) is disproportionately low in people with persistent atrial fibrillation (psAF). The common-sense model suggests illness perceptions and coping predict QoL in chronic illnesses. No previous studies have examined the idiosyncratic beliefs and coping behaviours of psAF patients. What does this study add? A vicious cycle of perceived lack of understanding of AF, attempts to control AF and distress at failed attempts at control, was a key theme. PsAF patients reported continued avoidance/all-or-nothing behaviours despite symptomatic relief post-procedure, and disengagement from enjoyable activities. PsAF patients reported procedure-specific concerns/expectations, which could be targeted in future interventions aimed at reducing distress.

Long-term symptom improvement and patient satisfaction following catheter ablation of supraventricular tachycardia: insights from the German ablation registry.

AIMS: To analyse outcomes of supraventricular tachycardia (SVT) ablations performed within a prospective German Ablation Quality Registry. METHODS AND RESULTS: Data from 12 566 patients who underwent catheter ablation of SVT between January 2007 and January 2010 to treat atrial fibrillation (AFIB, 37.2% of procedures), atrial flutter (AFL, 29.9%), atrioventricular nodal re-entrant tachycardia (AVNRT, 23.2%), atrioventricular re-entrant tachycardia (6.3%), and focal atrial tachycardia (AT, 3.4%) were prospectively collected. Patients were followed for at least 1 year. The periprocedural success rate was 96.3%, ranging from 84.3% (focal AT) to 98.9% (AVNRT). Kaplan-Meier mortality estimate at 1 year was 1.4% overall, and as high as 2.6% in the AFL group and 2.8% in the focal AT group. Recurrence of ablated or another symptomatic SVT was observed in 3783 (32.6%) of patients, ranging from 17.2% (AVNRT) to 45.6% (AFIB). Repeat ablation was performed in 12.0% of patients. After 1 year, 74.1% of survivors perceived ablation therapy as successful, 15.7% as partly successful, and 9.6% as unsuccessful. Even in those patients with arrhythmia recurrence, 76.0% perceived ablation as successful or partly successful and 89.6% would still undergo repeat ablation in the same institution. CONCLUSION: Ablation therapy for SVT is a safe procedure bringing symptomatic improvement and satisfaction to three quarters of patients after 1 year. Even in patients with arrhythmia recurrence, a high satisfaction level and adherence to the ablating institution could be documented. Strikingly high mortality and stroke rates in follow-up were observed in AFL patients, who apparently need consistent long-term anticoagulation and more medical attention.

Healthcare Utilization and Quality of Life Improvement after Ablation for Paroxysmal AF in Younger and Older Patients.

BACKGROUND: Atrial fibrillation (AF) prevalence increases significantly with age. Little is known about the effect of AF ablation on quality of life and healthcare utilization in the elderly. The objective of this study was to quantify the healthcare utilization and quality of life benefits of catheter ablation for AF, for patients ≥65 years compared to patients <65 years. METHODS: Two multicenter U.S. registry studies enrolled patients with paroxysmal AF. Baseline characteristics and acute outcomes were collected for 736 patients receiving catheter ablation with the Navistar® ThermoCool® SF Catheter (Biosense Webster, Inc., Diamond Bar, CA, USA). Healthcare utilization and quality of life outcomes were collected through 1 year postablation for 508 patients. RESULTS: The rates of acute pulmonary vein isolation were high and similar between patients ≥65 years and <65 years (97.5% vs 95.8%, P = 0.2130). Length of stay for the index procedure was similar between age groups with 82.2% of the older group and 83.2% of the younger group having one-day hospitalization. Disease-specific quality of life instrument scores improved significantly and similarly for older and younger patients at 1 year postablation, compared to baseline. AF-related hospitalizations and emergency department visits were similar or lower in older patients compared to younger patients, as reported at 1 year postablation. CONCLUSION: For older patients undergoing catheter ablation for paroxysmal AF, healthcare utilization parameters were lower or not significantly different than for younger patients, and quality of life outcomes were similarly improved. These findings support the use of catheter ablation as a treatment option in older patients with paroxysmal AF.

High Patient Satisfaction with Deep Sedation for Catheter Ablation of Cardiac Arrhythmia.

BACKGROUND: Patients' satisfaction with invasive procedures largely relies on periprocedural perception of pain and discomfort. The necessity for intraprocedural sedation during catheter ablation of cardiac arrhythmias for technical reasons is widely accepted, but data on patients' experience of pain and satisfaction with the procedural sedation are scarce. We have assessed patients' pain and discomfort during and after the procedure using a standardized questionnaire. METHODS: One hundred seventeen patients who underwent catheter ablation answered a standardized questionnaire on periprocedural perception of pain and discomfort after different anesthetic protocols with propofol/midazolam with and without additional piritramide and ketamine/midazolam. RESULTS: Patients report a high level of satisfaction with periprocedural sedation with 83% judging sedation as good or very good. The majority of patients was unconscious of the whole procedure and did not recollect experiencing pain. Procedural pain was reported by 7.7% of the patients and 16% reported adverse effects, e.g., postprocedural nausea and episodes of headache. CONCLUSION: The results of our study show that deep sedation during catheter ablation of cardiac arrhythmias is generally well tolerated and patients are satisfied with the procedure. Yet, a number of patients reports pain or adverse events. Therefore, studies comparing different sedation strategies should be conducted in order to optimize sedation and analgesia.

Patients' and Physicians' Perceptions Regarding the Benefits of Atrial Fibrillation Ablation.

BACKGROUND: It is unclear whether patients and physicians understand that atrial fibrillation ablation (AFA) has been shown to only improve symptomology and not reduce morbidity or mortality. METHODS: Note that 177 of 445 (40%) consecutive patients referred to an electrophysiology clinic for atrial fibrillation (AF) management responded anonymously to our survey via mail. Note that 105 of 656 (15%) physicians responded to our survey via email. Comparisons among groups were conducted using χ2 test for categorical variables. Odds ratios and 95% confidence intervals were estimated by using a multivariate logistic regression model. RESULTS: Almost half of patients and physicians believed AF ablation (AFA) would eliminate the need for anticoagulation (43% vs. 44%, P > 0.05) while the majority of both groups believed AFA would improve survival (58% vs. 67%, P = 0.308). The great majority of both groups believed AFA would decrease stroke rates (89% vs. 80%, P = 0.106). When comparing noncardiologists (n = 86) to cardiologists (n = 19), noncardiologists were more likely to believe that an AFA would eliminate the need for anticoagulation 49% vs. 21% (X = 4.9, P = 0.04), improve survival 80% vs. 11% (X = 30.2, P < 0.001), and decrease stroke 87% vs. 44% (X = 15.6, P < 0.001), respectively. CONCLUSIONS: The perceived benefit of AFA by patients and physicians is not supported by the medical literature. It is the responsibility of the electrophysiology community to educate patients and referring physicians regarding the true benefits of AFA. In addition, our study displays the great need for long-term clinical trials examining the impact AFA has on morbidity and mortality.

[Impacts of radiofrequency ablation on quality of life of atrial fibrillation patients with low CHA2DS2-VASc score].

OBJECTIVE: CHADS2 and CHA2DS2-VASc scores are two widely used systems for evaluating the risk of stroke in patients with atrial fibrillation (AF). The Quality of life (QoL) after a single radiofrequency ablation (RFA) in AF patients with low CHADS2 score has been established. This study was designed to further explore the association between the QoL and AF patients with low CHA2DS2-VASc score after RFA. METHODS: We selected 367 AF patients with low CHA2DS2-VASc score (CHA2DS2-VASc<2) from the Chinese Atrial Fibrillation Registry (CAFR) between 2011 and 2013. They all completed both baseline and 6-month Atrial Fibrillation Effect on Quality-of-Life (AFEQT) questionnaires. Propensity score matching was used to construct a final cohort of 105 patients. They were divided into two groups: RFA group (n=44) and non-RFA group (n=61). RESULTS: Baseline clinic characteristics, and each domain and global score of AFEQT were comparable between the two groups. Except for domain of treatment satisfaction in non-RFA group (mean score change from baseline to 6-month: 3.55, P= 0.13) , the other domains in this group (mean score change from baseline to 6-month: symptom, 14.66; daily activities, 12.56; treatment concern, 17.69; global score, 14.71, all P<0.05) and all the domains in RFA group improved greatly within-group comparison (mean score change from baseline to 6-month: symptom, 20.42; daily activities, 17.1; treatment concern, 20.36; global score, 18.75; treatment satisfaction, 9.66, all P<0.05). No significant differences were observed in all domains of baseline to 6-month changes between two groups (all P>0.05). CONCLUSIONS: No significant changes could be viewed in QoL between RFA and non-RFA AF patients with low CHA2DS2-VASc score, whose baseline AFEQT were balanced, and QoL from baseline to 6-month improves significantly.

Efficacy and safety of catheter ablation vs. rate control of atrial fibrillation in systolic left ventricular dysfunction : A meta-analysis and systematic review.

PURPOSE: It is unclear what constitutes the optimal strategy for management of atrial fibrillation (AF) in patients with systolic left ventricular (LV) dysfunction. We hypothesized that catheter ablation of AF had benefits compared with rate control in patients with systolic LV dysfunction. METHODS: PubMed, Embase, and the Cochrane Library were searched for randomized controlled trials and nonrandomized, observational studies. Weighted mean differences (WMD) and 95 % confidence intervals (CIs) were calculated to compare the improvement of left ventricular ejection fraction (LVEF), functional capacity, and quality of life between a catheter ablation group and a rate control group. RESULTS: Six trials with 324 patients were included in the analysis. Patients in the catheter ablation group had greater improvement of LVEF (WMD: 8.89; 95 % CI: 6.93-10.86; p < 0.001), 6-min walk distance (WMD: 46.9; 95 % CI: 28.5-65.4; p < 0.001), and lower Minnesota Living With Heart Failure Questionnaire (MLHFQ) scores (WMD: - 19.6; 95 % CI: - 23.6-- 15.7; p < 0.001) compared with patients in the rate control group. Overall, there were only ten procedure-related events and the procedure-related events rate was 4.9 % per procedure and 5.6 % per patient. CONCLUSION: The present analysis suggests that catheter ablation of AF has benefits in terms of an improvement in LVEF, in functional capacity, and in quality of life compared with rate control in patients with systolic LV dysfunction, and the risk of complications related to procedures is acceptable.

Cardiff cardiac ablation patient-reported outcome measure (C-CAP): validation of a new questionnaire set for patients undergoing catheter ablation for cardiac arrhythmias in the UK.

PURPOSE: To formally test and validate a patient-reported outcome measure (PROM) for patients with cardiac arrhythmias undergoing catheter ablation procedures in the UK [Cardiff Cardiac Ablation PROM (C-CAP)]. METHODS: A multicentre, prospective, observational cohort study with consecutive patient enrolment from three UK sites was conducted. Patients were sent C-CAP questionnaires before and after an ablation procedure. Pre-ablation C-CAP1 (17 items) comprised four domains: patient expectations; condition and symptoms; restricted activity and healthcare visits; medication and general health. Post-ablation C-CAP2 (19 items) comprised five domains including change in symptoms and procedural complications. Both questionnaires also included the generic EQ-5D-5L tool (EuroQol). Reliability, validity, and responsiveness measures were calculated. RESULTS: A total of 517 valid pre-ablation and 434 post-ablation responses were received; questionnaires showed good feasibility and item acceptability. Internal consistency was good (Cronbach's alpha >0.7) and test-retest reliability was acceptable for all scales. C-CAP scales showed high responsiveness (effect size >0.8). Patients improved significantly (p < 0.001) following ablation across all disease-specific and global scales. Minimal clinically important difference was calculated. Improvement beyond the smallest detectable change of 9 points (symptom severity scale), 3 points (frequency and duration of symptoms scale), and 8 points (impact on life scale) indicates an important change. Amendments to the C-CAP questionnaires were identified through the validation process and made to produce the final tools. CONCLUSIONS: The final C-CAP questionnaires are valid, reliable, and responsive tools for measuring symptom change, impact, and expectations in patients undergoing ablation for cardiac arrhythmias. C-CAP questionnaires provide a tool with disease-specific and generic domains to explore how cardiac ablation procedures in the UK impact upon patients' lives.

Differences in Quality of Life Between Atrial Fibrillation Patients with Low Stroke Risk Treated With and Without Catheter Ablation.

BACKGROUND: Impacts of a single radiofrequency ablation (RFA) on quality of life (QoL) were not well investigated in atrial fibrillation (AF) patients with low stroke risk. METHODS AND RESULTS: Nine hundred AF patients with low CHADS2 score (ie, CHADS2 ≤1) who completed both a baseline and 6-month Atrial Fibrillation Effect on QualiTy-of-life (AFEQT) questionnaire were selected from The Chinese Atrial Fibrillation Registry between 2011 and 2013. A final cohort of 222 patients was constructed after a propensity score matching with 74 in the RFA group and 148 in the non-RFA group. Domains of AFEQT were balanced at baseline between the 2 groups. No statistically significant differences were noted in QoL (all P>0.05) when AFEQT at 6 months was compared between groups, except for the symptoms domain (83.07±12.37 units in the RFA group vs. 77.68±17.14 units in the non-RFA group; P=0.008) and treatment satisfaction domain (76.34±14.92 units in the RFA group vs. 70.38±16.81 units in the non-RFA group; P=0.01). Within-group changes in all domains and the global score of the questionnaire were moderate to large, whereas between-group comparisons in baseline to 6-month changes and QoL at 6 months were small to moderate according to Cohen effect sizes. CONCLUSIONS: QoL was balanced at baseline and improved at 6 months in both groups from this observational propensity-matched cohort based on the AFEQT questionnaire. However, RFA treatment was only associated with small-to-moderate superiorities over non-RFA treatment. The role of RFA in QoL improvement among AF patients with low stroke risk requires further research.

Living on a knife edge-the daily struggle of coping with symptomatic cardiac arrhythmias.

BACKGROUND: In 2010 a retrospective audit was undertaken to assess the viability of using PROMs in patients with symptomatic cardiac arrhythmias having undergone percutaneous arrhythmia ablation. A response rate of 74 % was achieved, with finding suggesting that arrhythmia patients reported a significant impact on their work, social and family life. AIMS: To conduct a qualitative cross sectional survey to understand patients' perspectives of how cardiac arrhythmias affect their daily lives, as part of a program to develop a Patient Reported Outcome Measure (PROM). METHOD: Twenty five patients aged 18 or over, diagnosed with a variety of symptomatic cardiac arrhythmias referred for a cardiac ablation procedure took part in cognitive interviews. These aimed to inform the development of a patient reported outcome measure and to determine factors important to this patient group. Common themes were identified using content analysis. RESULTS: Participants reported that symptoms of their arrhythmia caused them considerable problems and impacted adversely on their quality of life in many ways. This extended through daily routine, work and social activities and also to friends and family, with fear and anxiety being significant factors for most responders. Patients felt their illness was poorly understood, even by health professionals, and often reported that they felt isolated, lacking support and information. CONCLUSION: Symptomatic cardiac arrhythmias are a source of debilitating and life limiting symptoms, having a negative impact on quality of life. Symptoms and related complications are relevant across different arrhythmia substrates and patient groups. TRIAL REGISTRATION: The study is registered on the Clinical Trials website, Identifier NCT01672528.

Visualisation during ablation of atrial fibrillation - stimulating the patient's own resources: Patients' experiences in relation to pain and anxiety during an intervention of visualisation.

BACKGROUND: Going through ablation of atrial fibrillation can be accompanied by pain and discomfort when a light, conscious sedation is used. Visualisation has been shown to reduce the patients' perception of pain and anxiety during invasive procedures, when it is used together with the usual pain management. PURPOSE: The purpose of this study was to investigate patients' experiences with visualisation in relation to pain and anxiety during an intervention consisting of visualisation, when undergoing ablation of atrial fibrillation. METHODS: Qualitative interviews were conducted with 14 patients from a study population of a clinical controlled study with 147 patients. The transcribed interviews were analysed according to qualitative methodology of inductive content analysis. FINDINGS: Four categories emerged from the interviews: 'approach to visualisation'; 'strategies of managing pain'; 'strategies of managing anxiety' and 'benefits of visualisation'. The transversal analyses revealed two overall themes which highlight the experiences of being guided in visualisation during ablation of atrial fibrillation: 'stimulation of the patients' own resources' and 'being satisfied without complete analgesia' CONCLUSION: Visualisation used during ablation of atrial fibrillation was reported as a positive experience with no serious inconvenience: It seemed that visualisation did not produce complete analgesia but the patients expressed that it provided some pain relief and supported their individual strategies in managing pain and anxiety. Our findings indicate that visualisation for acute pain during ablation of atrial fibrillation was associated not only with a decrease in experience of pain but also with high levels of treatment satisfaction and other non-pain-related benefits.

Catheter ablation of asymptomatic longstanding persistent atrial fibrillation: impact on quality of life, exercise performance, arrhythmia perception, and arrhythmia-free survival.

BACKGROUND: Impact of catheter ablation on exercise performance, quality of life (QoL) and symptom perception in asymptomatic longstanding persistent AF (LSP-AF) patients has not been reported yet. METHODS AND RESULTS: Sixty-one consecutive patients (mean age 62 ±13 years, 71% males) with asymptomatic LSP-AF undergoing first catheter ablation were enrolled. Extended pulmonary vein antrum isolation plus ablation of complex fractionated atrial electrograms and nonpulmonary vein triggers was performed in all. QoL survey was taken at baseline and 12-months postablation, using Short Form-36 (SF-36). Information on arrhythmia perception was obtained using a standard questionnaire and corroborating symptoms with documented evidence of arrhythmia. Exercise tests were performed on 38 patients at baseline and 5 months after procedure. Recurrence was assessed using event recorder, cardiology evaluation, electrocardiogram, and 7-day holter monitoring. After 20 ± 5 months follow-up, 36 (57%) patients remained recurrence-free off-AAD. Of the 25 patients experiencing recurrence, 21 (84%) were symptomatic. Compared to baseline, follow-up SF-36 scores improved significantly in many measures. For patients with successful ablation, physical component summary (PCS) and mental component summary (MCS) demonstrated substantial improvement ( MCS: 64.2 ± 22.3 to 70.1 ± 18.6 [P = 0.041]; PCS: 62.6 ± 18.4 to 70.0 ± 14.4 [P = 0.032]). Postablation exercise study in recurrence-free patients showed significant reduction in resting and peak heart rate (75 ± 11 vs. 90 ± 17 and 132 ± 20 vs. 154.5 ± 36, respectively, P < 0.001), increase in peak oxygen pulse (13.4 ± 3 vs. 18.9 ± 16 mL/beat, Δ5.5 ± 15, P = 0.001), peak VO2 /kg (19.7 ± 5 to 23.4 ± 13 mL/kg/min [Δ 3.7 ± 10, P = 0.043]), and corresponding MET (5.6 ± 1 to 6.7 ± 4 [Δ1.1 ± 3, P = 0.03]). No improvement was observed in patients with failed procedures. CONCLUSION: Successful ablation improves exercise performance and QoL in asymptomatic LSP-AF patients.