Cardiocenter, Department of Cardiology, Third Internal-Cardiology Clinic, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Srobarova 50, 100 34, Prague, Czech Republic.
Cardiocenter, Department of Cardiac Surgery, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Srobarova 50, 100 34, Prague, Czech Republic.
J Interv Card Electrophysiol. 2020 Apr;57(3):435-442. doi: 10.1007/s10840-019-00546-7. Epub 2019 Apr 17.
Hybrid ablation (i.e., a combination of a thoracoscopic surgical ablation followed by a catheter ablation) is a treatment option for patients with non-paroxysmal atrial fibrillation (AF). Despite its promising efficacy, it is a surgical procedure with a relatively high risk of complications that could affect the quality of life (QoL) of patients, even when sinus rhythm is restored.
To describe changes in the QoL of patients with non-paroxysmal AF before and after a hybrid ablation.
Patients after hybrid ablation for persistent or long-standing persistent AF were prospectively studied. Follow-up visits were scheduled at 1, 3, 6, 9, and 12 months. The maintenance of SR was assessed using 1-week Holter recordings at 6 and 12 months and 24-h Holter recordings at 3 and 9 months, or via an implantable loop recorder. QoL was assessed using the Atrial Fibrillation Effect on Quality-of-life (AFEQT) and the EuroQoL-5Dimensions (EQ-5D) questionnaires before and 12 months after ablation.
Seventy-five patients (49 men, age 62.9 ± 8.45 years, 48 (64%) with long-standing persistent AF) were enrolled. Fifty-two (69.3%, SR group) were AF-free during the 12-month follow-up, 16 (21.3%, PAROX group) had only paroxysms of AF after ablation, and 7 (9.3%, PERM group) were on rate control due to permanent AF reoccurrence. The AFEQT score increased significantly in the SR group from 59.9 ± 19.4 to 91.4 ± 10.8 (p < 0.001), and in the PAROX group from 58.8 ± 19.0 to 81.5 ± 14.1 (p = 0.002) but remained unchanged in the PERM group (44.6 ± 7.5 vs. 47.4 ± 5.5, p = 0.24). The EQ-5D score significantly decreased in the descriptive part (from 7.90 ± 2.61 to 6.64 ± 1.90, p = 0.0001) and increased on the visual analog scale (from 63.56 ± 19.11 to 79.30 ± 16.9, p < 0.0001) in the SR group. In the PAROX group, no significant change was present on either the descriptive part (p = 0.3) or in the visual analog scale (p = 0.48). Similarly, no significant changes were present on either the descriptive part (p = 0.93) or the visual analog scale (p = 0.4) in the PERM group.
The QoL of patients with non-paroxysmal AF and patients with AF paroxysms, after successful hybrid ablation, improved significantly in patients with SR. No significant improvement was present in patients on rate control after an unsuccessful ablation.
对于非阵发性心房颤动（AF）患者，混合消融（即胸腔镜手术消融联合导管消融的组合）是一种治疗选择。尽管其疗效有希望，但它是一种具有相对较高并发症风险的手术，即使恢复窦性心律，也可能影响患者的生活质量（QoL）。
描述非阵发性 AF 患者在混合消融前后 QoL 的变化。
前瞻性研究接受持续性或长程持续性 AF 混合消融的患者。随访安排在 1、3、6、9 和 12 个月。通过 6 和 12 个月的 1 周 Holter 记录和 3 和 9 个月的植入式环路记录，或通过植入式环路记录，评估 SR 的维持情况。消融前和消融后 12 个月使用心房颤动对生活质量的影响（AFEQT）和欧洲五维健康量表（EQ-5D）问卷评估 QoL。
共纳入 75 例患者（49 例男性，年龄 62.9±8.45 岁，48 例（64%）为长程持续性 AF）。52 例（69.3%，SR 组）在 12 个月随访期间无 AF 发作，16 例（21.3%，PAROX 组）消融后仅有阵发性 AF，7 例（9.3%，PERM 组）因永久性 AF 复发而接受心率控制。SR 组的 AFEQT 评分从 59.9±19.4 显著增加到 91.4±10.8（p<0.001），PAROX 组从 58.8±19.0 显著增加到 81.5±14.1（p=0.002），但 PERM 组无变化（44.6±7.5 vs. 47.4±5.5，p=0.24）。SR 组描述性部分的 EQ-5D 评分显著下降（从 7.90±2.61 降至 6.64±1.90，p=0.0001），视觉模拟量表评分显著升高（从 63.56±19.11 升至 79.30±16.9，p<0.0001）。PAROX 组描述性部分（p=0.3）和视觉模拟量表（p=0.48）均无显著变化。同样，PERM 组描述性部分（p=0.93）和视觉模拟量表（p=0.4）均无显著变化。
对于非阵发性 AF 患者和阵发性 AF 患者，成功的混合消融后，SR 患者的生活质量显著改善。消融不成功的患者进行心率控制后，生活质量无显著改善。
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