oru.sePublications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • 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
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?
Örebro University, School of Medical Sciences.
Odense University Hospital, Odense, Denmark.
(Clinical Epidemiology and Biostatistics)
Odense University Hospital, Odense, Denmark.
Show others and affiliations
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. Vol. 3, no 10, p. 1168-1176
Keywords [en]
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: urn:nbn:se:oru:diva-66207DOI: 10.1016/j.jacep.2017.04.003Scopus ID: 2-s2.0-85021385993OAI: oai:DiVA.org:oru-66207DiVA, id: diva2:1193930
Available from: 2018-03-28 Created: 2018-03-28 Last updated: 2018-08-16Bibliographically approved
In thesis
1. Catheter ablation for atrial fibrillation: effects on rhythm, symptoms and health-related quality of life
Open this publication in new window or tab >>Catheter ablation for atrial fibrillation: effects on rhythm, symptoms and health-related quality of life
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
Atrial fibrillation, catheter ablation, symptoms, quality of life
National Category
General Practice
Identifiers
urn:nbn:se:oru:diva-65015 (URN)978-91-7529-237-3 (ISBN)
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

Open Access in DiVA

No full text in DiVA

Other links

Publisher's full textScopus

Authority records BETA

Björkenheim, AnnaPoçi, Dritan

Search in DiVA

By author/editor
Björkenheim, AnnaPoçi, Dritan
By organisation
School of Medical SciencesÖrebro University Hospital
Cardiac and Cardiovascular Systems

Search outside of DiVA

GoogleGoogle Scholar

doi
urn-nbn

Altmetric score

doi
urn-nbn
Total: 122 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • 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