Svedung Wettervik Victoria, Schwieler Jonas, Bergfeldt Lennart, Kennebäck Göran, Jensen Steen, Rubulis Aigars, Sciaraffia Elena, Blomström-Lundqvist Carina
Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.
Heart Rhythm. 2025 Apr;22(4):944-951. doi: 10.1016/j.hrthm.2024.09.044. Epub 2024 Sep 21.
Data on long-term effects of catheter ablation vs antiarrhythmic drugs (AADs) on health-related quality of life (HRQoL) and atrial fibrillation (AF) burden are limited.
The study aimed to assess long-term HRQoL and rhythm data in patients with symptomatic AF.
The 75 patients who underwent ablation and 74 receiving AADs in the Catheter Ablation compared with Pharmacological Therapy for Atrial Fibrillation (CAPTAF) trial were followed for 48 months. The General Health subscale of the 36-Item Short-Form Health Survey, time to first AF episode ≥1 hour, and AF burden, recorded by implantable cardiac monitors, were compared.
One hundred forty-seven patients completed follow-up, with 7 crossovers in the ablation group and 34 crossovers in the AAD group. General Health improved by ablation from a median of 62 points at baseline to 79.2 points at follow-up (P < .001) and by AADfrom a median of 67 to 77 points (P < .001), without treatment differences (P = .77). Time to first AF episode ≥1 hour was longer (median 257 days in the ablation group vs 180 days in the AAD group; P = .025). The cumulative AF burden during follow-up was lower in the ablation group (median 0.3%; interquartile range [IQR] 0%-1.4%) than in the AAD group (1.6%; IQR 0.1%-11.0%); P = .01. The cumulative reduction in AF burden compared with baseline was greater in the ablation group (median -89.5%; IQR -98.4% to -51.3%) than in the AAD group (-52.7%; IQR -92.6% to 263.6%); P < .001.
HRQoL improvement in long-term did not differ between ablation and AAD groups despite a larger reduction in AF burden after ablation. The results should be interpreted in the light of a high crossover rate in the AAD group.
关于导管消融术与抗心律失常药物（AADs）对健康相关生活质量（HRQoL）和房颤（AF）负荷的长期影响的数据有限。
本研究旨在评估有症状房颤患者的长期HRQoL和心律数据。
在房颤导管消融与药物治疗比较（CAPTAF）试验中，对75例行消融术的患者和74例接受AADs治疗的患者进行了48个月的随访。比较了36项简短健康调查问卷的总体健康子量表、首次房颤发作≥1小时的时间以及通过植入式心脏监测器记录的房颤负荷。
147例患者完成随访，消融组有7例交叉，AAD组有34例交叉。消融使总体健康状况从基线时的中位数62分提高到随访时的79.2分（P <.001），AAD使总体健康状况从中位数67分提高到77分（P <.001），两组间无治疗差异（P =.77）。首次房颤发作≥1小时的时间更长（消融组中位数为257天，AAD组为180天；P =.025）。随访期间，消融组的累积房颤负荷低于AAD组（中位数0.3%；四分位间距[IQR] 0% - 1.4%）（1.6%；IQR 0.1% - 11.0%）；P =.01。与基线相比，消融组房颤负荷的累积降低幅度大于AAD组（中位数 - 89.5%；IQR - 98.4%至 - 51.3%）（- 52.7%；IQR - 92.6%至263.6%）；P <.001。
尽管消融术后房颤负荷降低幅度更大，但消融组和AAD组长期HRQoL改善情况无差异。鉴于AAD组的高交叉率，应谨慎解读这些结果。
