Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA.
J Am Coll Cardiol. 2010 May 25;55(21):2308-16. doi: 10.1016/j.jacc.2010.01.040.
We sought to determine the relationship between atrial fibrillation (AF) ablation efficacy, quality of life (QoL), and AF-specific symptoms at 2 years.
Although the primary goal of AF ablation is QoL improvement, this effect has yet to be demonstrated in the long term.
A total of 502 symptomatic AF ablation recipients were prospectively followed for recurrence, QoL, and AF symptoms.
In 323 patients with 2 years of follow-up, 72% achieved AF elimination off antiarrhythmic drugs (AADs), 15% achieved AF control with AADs, and 13% had recurrent AF. The physical component summary scores of the Medical Outcomes Study Short Form 36 increased from 58.8 +/- 20.1 to 76.2 +/- 19.2 (p < 0.001) and the mental component summary scores of the Short Form 36 increased from 65.3 +/- 18.6 to 79.8 +/- 15.8 (p < 0.001). Post-ablation QoL improvements were noted across ablation outcomes, including recurrent AF (change in physical component summary: 12.1 +/- 19.7 and change in mental component summary: 9.7 +/- 17.9), with no significant differences in QoL improvement across 3 ablative efficacy outcomes. However, in 103 patients who completed additional assessment with Mayo AF Symptom Inventories (on a scale of 0 to 48), those with AF elimination off AADs had a change in AF symptom frequency score of -9.5 +/- 6.3, which was significantly higher than those with AF controlled with AADs (-5.6 +/- 3.8, p = 0.03) or those with recurrent AF (-3.4 +/- 8.4, p = 0.02). Independent predictors of limited QoL improvement included higher baseline QoL, obesity, and warfarin use at follow-up.
AF ablation produces sustained QoL improvement at 2 years in patients with and without recurrence. AF-specific symptom assessment more accurately reflects ablative efficacy.
我们旨在确定心房颤动（AF）消融疗效、生活质量（QoL）和 AF 特异性症状之间的关系在 2 年时的关系。
尽管 AF 消融的主要目标是改善 QoL，但这一效果尚未在长期内得到证实。
总共前瞻性地随访了 502 例有症状的 AF 消融受者，以了解复发、QoL 和 AF 症状。
在 323 例随访 2 年的患者中，72%的患者在停用抗心律失常药物（AAD）后消除 AF，15%的患者在使用 AAD 时控制 AF，13%的患者出现 AF 复发。医疗结局研究短表 36 的物理成分综合评分从 58.8±20.1 增加到 76.2±19.2（p<0.001），短表 36 的心理成分综合评分从 65.3±18.6 增加到 79.8±15.8（p<0.001）。消融结果均显示出 QoL 的改善，包括 AF 复发（物理成分综合评分的变化：12.1±19.7；心理成分综合评分的变化：9.7±17.9），3 种消融疗效结果之间的 QoL 改善无显著差异。然而，在 103 例完成了梅奥 AF 症状量表（0 到 48 分）额外评估的患者中，那些停用 AAD 后消除 AF 的患者的 AF 症状频率评分变化为-9.5±6.3，显著高于那些使用 AAD 控制 AF 的患者（-5.6±3.8，p=0.03）或那些复发 AF 的患者（-3.4±8.4，p=0.02）。QoL 改善有限的独立预测因素包括基线 QoL 较高、肥胖和随访时使用华法林。
在有或无复发的患者中，AF 消融在 2 年内可持续改善 QoL。AF 特异性症状评估更准确地反映消融疗效。
