Quality of life after use of the patient activated atrial defibrillator.

The aim of the study was to evaluate the effects of long-term use of the patient-activated atrial defibrillator for recurrent persistent atrial fibrillation (AF) on quality of life (QOL). Fifteen patients were implanted with the Medtronic Jewel AF 7250 device (dual chamber atrial and ventricular defibrillator) for AF only. AF recurrences were treated by out-of-hospital patient-activated atrial defibrillation shocks following the self-administration of oral sedation. QOL was assessed at pre-implant and up to one year with SF36, symptom checklist and HADS questionnaires. A total of 238 (median 10) out-of-hospital patient-activated atrial defibrillation shocks were performed. The SF36 demonstrated a trend toward improvement over the 12-month period compared with baseline values. There was no significant change in the symptom frequency or severity scores. Pre-implant levels of both anxiety and depression were within the predefined range of normality (6 +/- 3 and 3 +/- 2, respectively) and no significant change was seen at 6 months (5 +/- 4 and 3 +/- 3) or 12 months post implant (5 +/- 4 and 2 +/- 2, respectively). After one year of follow-up, 13 (87%) patients said they would have the device implanted again (two were undecided). The study demonstrates that patient-activated atrial defibrillation is a well tolerated therapeutic strategy for maintaining sinus rhythm.