再次消融治疗心房颤动对患者报告结局和生活质量的影响。
Impact of redo ablation for atrial fibrillation on patient-reported outcomes and quality of life.
机构信息
Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA.
Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA.
出版信息
J Cardiovasc Electrophysiol. 2023 Jan;34(1):54-61. doi: 10.1111/jce.15710. Epub 2022 Nov 2.
INTRODUCTION
Catheter ablation for atrial fibrillation (AF) is frequently used for the purpose of rhythm control and improved quality of life (QoL). Although success rates are high, a significant proportion of patients require redo ablation. Data are scarce on patient-centered outcomes and QoL in patients undergoing redo AF ablation. We aimed to assess QoL and clinical outcomes using a large prospectively maintained patient-reported outcomes (PRO) registry.
METHODS
All patients undergoing redo AF ablation (2013-2016) at our center were enrolled in a prospective registry for outcomes and assessed for QoL using automated PRO surveys (baseline, 3 and 6 months after ablation, every 6 months thereafter). Data were collected over 3 years of follow-up. The atrial fibrillation symptom severity scale (AFSSS) was used as the main measure for QoL. Additional variables included patient-reported improvement, AF burden, and AF-related healthcare utilization including emergency room (ER) visits and hospitalizations.
RESULTS
A total of 848 patients were included (28% females, mean age 63.8, 51% persistent AF). By automated PRO, significant improvement in QoL was noted (baseline median AFSSS of 12 [5-18] and ranged between 2 and 4 on subsequent assessments; p < .0001), with ≥70%of patients reported remarkable improvement in their AF-related symptoms. The proportion of patients in AF at the time of baseline survey was 36%, and this decreased to <8% across all time points during follow-up (p < .0001). AF burden was significantly reduced (including frequency and duration of episodes; p < .0001), with an associated decrease in healthcare utilization after 6 months from the time of ablation (including ER visits and hospitalizations; p < .0001). The proportion of patients on anticoagulants or antiarrhythmics decreased on follow-up across all time points (p < .0001 for all variables).
CONCLUSION
Most patients derive significant QoL benefit from redo AF ablation; with reduction of both AF burden and healthcare utilization.
简介
房颤（AF）的导管消融术常用于节律控制和提高生活质量（QoL）。尽管成功率很高，但仍有相当一部分患者需要再次消融。目前关于再次接受 AF 消融的患者的以患者为中心的结局和生活质量的数据很少。我们旨在使用大型前瞻性维护的患者报告结局（PRO）登记处评估 QoL 和临床结局。
方法
我们中心所有再次接受 AF 消融的患者（2013-2016 年）都被纳入前瞻性结局登记处，并使用自动 PRO 调查评估 QoL（消融前、消融后 3 个月和 6 个月，此后每 6 个月一次）。数据在 3 年的随访期间收集。房颤症状严重程度量表（AFSSS）被用作 QoL 的主要测量指标。其他变量包括患者报告的改善、房颤负担以及房颤相关的医疗保健利用，包括急诊室（ER）就诊和住院治疗。
结果
共纳入 848 例患者（女性占 28%，平均年龄 63.8 岁，51%为持续性 AF）。通过自动 PRO，发现 QoL 显著改善（基线时 AFSSS 的中位数为 12 [5-18]，随后的评估中范围在 2-4 之间；p<0.0001），超过 70%的患者报告他们的房颤相关症状有明显改善。基线调查时处于房颤状态的患者比例为 36%，在随访期间的所有时间点均降至<8%（p<0.0001）。房颤负担显著降低（包括发作的频率和持续时间；p<0.0001），消融后 6 个月时医疗保健利用也随之减少（包括 ER 就诊和住院治疗；p<0.0001）。在所有时间点，接受抗凝或抗心律失常药物治疗的患者比例随时间推移而下降（所有变量的 p<0.0001）。
结论
大多数患者从再次接受 AF 消融中获得显著的 QoL 获益；同时降低了房颤负担和医疗保健利用。
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