oru.sePublications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Catheter ablation for atrial fibrillation: effects on rhythm, symptoms and health-related quality of life
Örebro University, School of Medical Sciences.
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: AF ablation is an increasingly used treatment in patients with AF to improve patient-reported outcomes (PROs). Atrioventricular junction ablation (AVJA) is a palliative treatment option in therapy refractory AF that improves PROs but renders the patient pacemaker dependent.

Aims: To evaluate rhythm control and PROs before and up to two years after AF ablation. To analyze the long-term incidence of and predictors of hospitalization for HF and all-cause mortality in patients who underwent AVJA and right ventricular pacing.

Methods and Results: Fifty-four patients underwent AF ablation and both continuous rhythm monitoring via an implantable loop recorder (ILR) and intermittent rhythm monitoring three, six, 12 and 24 months after ablation. 76 % of patients had at least one AF recurrence, of whom 24 % were only detected by ILR. One third of symptom recordings did not show AF. The AF-specific AF6 scores, physician-assessed EHRA symptom class and both SF-36 summary scores all improved significantly from before to two years after ablation. There was a weak correlation between the change in AF6 scores and EHRA class from before to six and 12 months but not to 24 months after ablation. Responders to ablation (AF burden < 0.5 %), reached age- and sex-matched norms in all SF-36 domains, but non-responders only in social functioning and MCS. All AF6 scores showed at least moderate improvement in both responders and non-responders. Higher AF burden was independently associated with poorer PCS and AF6 scores. In 162 patients who underwent AVJA, hospitalization for HF occurred in 20 % of patients (two-year cumula-tive incidence 9.1 %) and 22 % died (two-year cumulative incidence 5.2 %) during a median follow-up of five years. QRS ≥ 120 ms and left atrial diame-ter were independent predictors of hospitalization for HF, and hypertension and previous HF of death.

Conclusions: Continuous rhythm monitoring was superior to intermittent monitoring. The AF-specific AF6 was more sensitive to changes related to AF burden after AF ablation than both EHRA class and the SF-36. The long-term hospitalization rate for HF and all-cause mortality was low after AVJA.

Place, publisher, year, edition, pages
Örebro: Örebro University , 2018. , p. 92
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 175
Keywords [en]
Atrial fibrillation, catheter ablation, symptoms, quality of life
National Category
General Practice
Identifiers
URN: urn:nbn:se:oru:diva-65015ISBN: 978-91-7529-237-3 (print)OAI: oai:DiVA.org:oru-65015DiVA, id: diva2:1182977
Public defence
2018-04-20, Örebro universitet, Campus USÖ, hörsal C1, Södra Grev Rosengatan 32, Örebro, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2018-02-15 Created: 2018-02-15 Last updated: 2018-03-28Bibliographically approved
List of papers
1. Predictors of hospitalization for heart failure and of all-cause mortality after atrioventricular nodal ablation and right ventricular pacing for atrial fibrillation
Open this publication in new window or tab >>Predictors of hospitalization for heart failure and of all-cause mortality after atrioventricular nodal ablation and right ventricular pacing for atrial fibrillation
Show others...
2014 (English)In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 16, no 12, p. 1772-1778Article in journal (Refereed) Published
Abstract [en]

Aims: Atrioventricular junction ablation (AVJA) is a highly effective treatment in patients with therapy refractory atrial fibrillation (AF) but renders the patient pacemaker dependent. We aimed to analyse the long-term incidence of hospitalization for heart failure (HF) and all-cause mortality in patients who underwent AVJA because of AF and to determine predictors for HF and mortality.

Methods and results: We retrospectively enrolled 162 consecutive patients, mean age 67 +/- 9 years, 48% women, who underwent AVJA because of symptomatic AF refractory to pharmacological treatment (n = 117) or unsuccessful repeated pulmonary vein isolation (n = 45). Hospitalization for HF occurred in 32 (20%) patients and 35 (22%) patients died, representing a cumulative incidence for hospitalization for HF and mortality over the first 2 years after AVJA of 9.1 and 5.2%, respectively. Hospitalization for HF occurred to the same extent in patients who failed pharmacological treatment as in patients with repeated pulmonary vein isolation (PVI), although the mortality was slightly higher in the former group. QRS prolongation >= 120 ms and left atrial diameter were independent predictors of hospitalization for HF, while hypertension and previous HF were independent predictors of death.

Conclusion: The long-term hospitalization rate for HF and all-cause mortality was low, which implies that long-term ventricular pacing was not harmful in this patient population, including patients with unsuccessful repeated PVI.

Place, publisher, year, edition, pages
Oxford University Press, 2014
Keywords
Atrial fibrillation, Atrioventricular junction ablation, Heart failure, Hospitalization, Mortality
National Category
Cardiac and Cardiovascular Systems
Research subject
Cardiology
Identifiers
urn:nbn:se:oru:diva-42367 (URN)10.1093/europace/euu171 (DOI)000347104900016 ()25031234 (PubMedID)
Note

Funding Agency:

Örebro Heart Foundation

Research Committee of Örebro University Hospital

Available from: 2015-02-04 Created: 2015-02-03 Last updated: 2018-06-15Bibliographically approved
2. Rhythm Control and its Relation to Symptoms During the First Two Years After Radiofrequency Ablation for Atrial Fibrillation
Open this publication in new window or tab >>Rhythm Control and its Relation to Symptoms During the First Two Years After Radiofrequency Ablation for Atrial Fibrillation
Show others...
2016 (English)In: Pacing and Clinical Electrophysiology, ISSN 0147-8389, E-ISSN 1540-8159, Vol. 39, no 9, p. 914-925Article in journal (Refereed) Published
Abstract [en]

Objective: To evaluate rhythm control up to two years after AF ablation and its relation to reported symptoms.

Background: The implantable loop recorder (ILR) continuously records the ECG, has an automatic AF detection algorithm and a possibility for patients to activate an ECG recording during symptoms.

Methods: Fifty-seven patients (mean age 57±9 years, 60% male, 88% paroxysmal AF) underwent AF ablation following ILR implantation. Device data were downloaded at the ablation and three, six, 12, 18 and 24 months after ablation.

Results: Fifty-four patients completed the two-year follow-up. Thirteen (24%) patients had no AF episodes detected by ILR during follow-up. Ten of 41 patients (24%) with AF recurrence were only detected by ILR and AF recurrences were detected earlier by ILR (P<0.001). The median AF burden in patients with AF recurrence was 5.7% (IQR 0.4-14.4) and was even lower in patients with AF only detected by ILR (P = 0.001). Forty-eight % of the patients indicated symptoms via the patient activator but 33% of those recordings were not due to AF. Early AF recurrence (within 3 months) was highly associated with later AF recurrence (P<0.001). AF burden >0.5% and longest >6h before the ablation were independent predictors of AF recurrence during intermittent but not continuous monitoring.

Conclusions: After AF ablation, the AF burden was low throughout the 24 months follow-up. Nevertheless, symptoms were commonly indicated but one third of patient activated recordings did not show AF. Continuous monitoring was superior to intermittent follow-up in detecting AF episodes and assessing the AF burden.

Clinical trial registration: URL: http://clinicaltrials.gov. Unique Identifier: NCT00697359.

Place, publisher, year, edition, pages
Hoboken, USA: Wiley-Blackwell Publishing Inc., 2016
Keywords
Atrial fibrillation, catheter ablation, implantable loop recorder, monitoring, symptoms
National Category
Cardiac and Cardiovascular Systems
Research subject
Cardiology
Identifiers
urn:nbn:se:oru:diva-51530 (URN)10.1111/pace.12916 (DOI)000383572900002 ()27418324 (PubMedID)2-s2.0-84987723704 (Scopus ID)
Note

Funding Agencies:

Medtronic

Örebro heart foundation

Research Committee of Örebro University Hospital, Örebro, Sweden

Available from: 2016-08-04 Created: 2016-08-02 Last updated: 2018-07-16Bibliographically approved
3. Assessment of Atrial Fibrillation–Specific Symptoms Before and 2 Years After Atrial Fibrillation Ablation: Do Patients and Physicians Differ in Their Perception of Symptom Relief?
Open this publication in new window or tab >>Assessment of Atrial Fibrillation–Specific Symptoms Before and 2 Years After Atrial Fibrillation Ablation: Do Patients and Physicians Differ in Their Perception of Symptom Relief?
Show others...
2017 (English)In: JACC: Clinical Electrophysiology, ISSN 2405-500X, Vol. 3, no 10, p. 1168-1176Article in journal (Refereed) Published
Abstract [en]

Objectives: The aim of this study was to evaluate patient-reported and physician-assessed atrial fibrillation (AF)–related symptoms after AF ablation.

Background: Success of AF ablation is usually defined as freedom from AF, although symptom relief is often patients’ desire.

Methods: Symptom relief was assessed as perceived by patients using the short, validated, AF-specific symptom questionnaire AF6 and as classified by physicians using the European Heart Rhythm Association (EHRA) classification at baseline and 6, 12, and 24 months after AF ablation. Recurrence of arrhythmia was documented by continuous electrocardiographic monitoring.

Results: In total, 54 patients completed the 24-month follow-up. All 6 items on the AF6, AF6 sum score, and EHRA class improved significantly over time. The greatest improvement was seen during the first 6 months after ablation, but AF6 scores showed continued improvement up to 12 months, in contrast to EHRA class. There was a low correlation between AF6 score and EHRA class, but the predictive ability was low. Both AF6 scores and EHRA class were significantly correlated with AF burden at all times after ablation. A change of >9 points in AF6 sum score corresponded to a meaningful reduction in symptom severity.

Conclusion: Patient-reported and physician-assessed outcomes were both useful in assessing symptom relief after AF ablation, although patient-reported outcomes were more sensitive tools. There was also a discrepancy between patient-reported and physician-assessed outcomes after ablation. Freedom from AF and a low AF burden most often resulted in a reduction of symptoms, but symptom relief also occurred despite little effect on the arrhythmia.

Place, publisher, year, edition, pages
Elsevier, 2017
Keywords
atrial fibrillation, catheter ablation, symptoms, beta adrenergic receptor blocking agent, warfarin, ablation therapy, adult, aged, Article, cardiac patient, classification, controlled study, electrocardiography, european heart rhythm association classification, female, follow up, freedom, general condition improvement, human, major clinical study, male, multicenter study, patient-reported outcome, perception, physician, priority journal, recurrent disease
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:oru:diva-66207 (URN)10.1016/j.jacep.2017.04.003 (DOI)2-s2.0-85021385993 (Scopus ID)
Available from: 2018-03-28 Created: 2018-03-28 Last updated: 2018-08-16Bibliographically approved
4. Patient-Reported Outcomes in Relation to Continuously Monitored Rhythm Before and During 2 Years After Atrial Fibrillation Ablation Using a Disease-Specific and a Generic Instrument
Open this publication in new window or tab >>Patient-Reported Outcomes in Relation to Continuously Monitored Rhythm Before and During 2 Years After Atrial Fibrillation Ablation Using a Disease-Specific and a Generic Instrument
Show others...
2018 (English)In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, ISSN 2047-9980, E-ISSN 2047-9980, Vol. 7, no 5, article id e008362Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Atrial fibrillation (AF) ablation improves patient-reported outcomes, irrespective of mode of intermittent rhythm monitoring. We evaluated the use of an AF-specific and a generic patient-reported outcomes instrument during continuous rhythm monitoring 2 years after AF ablation.

METHODS AND RESULTS: Fifty-four patients completed the generic 36-Item Short-Form Health Survey and the AF-specific AF6 questionnaires before and 6, 12, and 24 months after AF ablation. All patients underwent continuous ECG monitoring via an implantable loop recorder. The generic patient-reported outcomes scores were compared with those of a Swedish age- and sex-matched population. After ablation, both summary scores reached normative levels at 24 months, while role-physical and vitality remained lower than norms. Responders to ablation (AF burden <0.5%) reached the norms in all individual 36-Item Short-Form Health Survey domains, while nonresponders (AF burden >0.5%) reached norms only in social functioning and mental component summary. All AF6 items and the sum score showed moderate to large improvement in both responders and nonresponders, although responders showed significantly greater improvement in all items except item 1 from before to 24 months after ablation. Higher AF burden was independently associated with poorer physical component summary and AF6 sum score.

CONCLUSIONS: The AF-specific AF6 questionnaire was more sensitive to changes related to AF burden than the generic 36-Item Short-Form Health Survey. Patients improved as documented by both instruments, but a higher AF burden after ablation was associated with poorer AF-specific patient-reported outcomes and poorer generic physical but not mental health. Our results support the use of an AF-specific instrument, alone or in combination with a generic instrument, to assess the effect of ablation.

CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT00697359.

Place, publisher, year, edition, pages
Wiley-Blackwell Publishing Inc., 2018
Keywords
Atrial fibrillation, catheter ablation, quality of life
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:oru:diva-65285 (URN)10.1161/JAHA.117.008362 (DOI)000430007700018 ()29478027 (PubMedID)2-s2.0-85042700710 (Scopus ID)
Note

Funding Agencies:

Örebro Heart Foundation  

Research Committee of Örebro University Hospital, Örebro, Sweden 

Available from: 2018-02-27 Created: 2018-02-27 Last updated: 2018-08-20Bibliographically approved

Open Access in DiVA

Cover(303 kB)4 downloads
File information
File name COVER01.pdfFile size 303 kBChecksum SHA-512
52bfb040cfa6c4cd3a3528271f5e152eebc076e70119d4b6562b95833c92f79ec8837413fee15983ce9f587032593fd35d86630ddf5d8ab570fa21bcbfffe885
Type coverMimetype application/pdf
Spikblad(123 kB)1 downloads
File information
File name SPIKBLAD01.pdfFile size 123 kBChecksum SHA-512
62c06b766259d17778347d4379f918d15bce2651f33b58d9d0b20a9353a81515b215ada5444d3cebf9656c40e5c26ac33e513e8ca47b498c46494032f0b94794
Type spikbladMimetype application/pdf
Catheter ablation for atrial fibrillation: effects on rhythm, symptoms and health-related quality of life(2142 kB)29 downloads
File information
File name FULLTEXT01.pdfFile size 2142 kBChecksum SHA-512
f69efe8491fedc0b8b2ce76dca49da7f3fb77f66e1a809c96c30f840db2d47d58a9b9788356d773c54dc2a73629e6f31b29139741ba454d0bc0803c7b8ed2dce
Type fulltextMimetype application/pdf

Authority records BETA

Björkenheim, Anna

Search in DiVA

By author/editor
Björkenheim, Anna
By organisation
School of Medical Sciences
General Practice

Search outside of DiVA

GoogleGoogle Scholar
Total: 29 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

isbn
urn-nbn

Altmetric score

isbn
urn-nbn
Total: 295 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf