Changes in quality of life, cognition and functional status following catheter ablation of atrial fibrillation.

Autor:	Piccini JP; Division of Cardiology, Duke University Medical Center & Duke Clinical Research Institute, Durham, North Carolina, USA jonathan.piccini@duke.edu., Todd DM; Cardiology, Liverpool Heart and Chest Hospital, Liverpool, UK., Massaro T; Biostatistics, Duke University Medical Center, Durham, North Carolina, USA., Lougee A; Biostatistics, Duke Clinical Research Institute, Durham, North Carolina, USA., Haeusler KG; Department of Neurology, Universitätsklinikum Würzburg, Wurzburg, Germany.; Atrial Fibrillation NETwork association (AFNET), Munster, Germany., Blank B; Atrial Fibrillation NETwork association (AFNET), Munster, Germany., de Bono JP; Institute of Cardiovascular Sciences, University Hospital Birmingham, Birmingham, West Midlands, UK., Callans DJ; Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA., Elvan A; Cardiology, Isala Klinieken, Zwolle, The Netherlands., Fetsch T; Cardiology, The Clinical Research Institute, Muncher, Germany., Van Gelder I; Cardiology, University Medical Centre Groningen Thorax Centre, Groningen, The Netherlands., Gentlesk P; Cardiology, Sentara Norfolk General Hospital, Norfolk, Virginia, USA., Grimaldi M; Ente Ecclesiastico Ospedale Generale Regionale Francesco Miulli, Acquaviva delle Fonti, Puglia, Italy., Hansen J; Department of Cardiology, Gentofte Hospital, Gentofte, Hovedstaden, Denmark., Hindricks G; Cardiology, University of Leipzig, Leipzig, Germany., Al-Khalidi H; Duke Clinical Research Institute, Durham, North Carolina, USA., Mont L; Cardiovascular Institute, University of Barcelona, Barcelona, Spain., Nielsen JC; Cardiology B, Aarhus University Hospital, Aarhus N, Denmark., Noelker G; Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany., De Potter T; Cardiology, Onze Lieve Vrouw Ziekenhuis, Aalst, Belgium., Scherr D; Cardiology, Medical University of Graz, Graz, Austria.; Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, Limburg, Netherlands., Schotten U; Physiology, Maastricht University Medical Centre, Maastricht, The Netherlands., Themistoclakis S; Cardiology, Ospedale Dell'Angelo, Mestre-Venice, Italy., Vijgen J; Heart Center, Jessa Hospital, Hasselt, Belgium., Di Biase L; Cardiology, Montefiore Medical Center, Bronx, New York, USA., Kirchhof P; Atrial Fibrillation NETwork association (AFNET), Munster, Germany.; Institute of Cardiovascular Sciences, University Hospital Birmingham, Birmingham, West Midlands, UK.; SWBH NHS Trust, Birmingham, UK.
Jazyk:	angličtina
Zdroj:	Heart (British Cardiac Society) [Heart] 2020 Dec; Vol. 106 (24), pp. 1919-1926. Date of Electronic Publication: 2020 Oct 12.
DOI:	10.1136/heartjnl-2020-316612
Abstrakt:	Objective: To investigate changes in quality of life (QoL), cognition and functional status according to arrhythmia recurrence after atrial fibrillation (AF) ablation. Methods: We compared QoL, cognition and functional status in patients with recurrent atrial tachycardia (AT)/AF versus those without recurrent AT/AF in the AXAFA-AFNET 5 clinical trial. We also sought to identify factors associated with improvement in QoL and functional status following AF ablation by overall change scores with and without analysis of covariance (ANCOVA). Results: Among 518 patients who underwent AF ablation, 154 (29.7%) experienced recurrent AT/AF at 3 months. Patients with recurrent AT/AF had higher mean CHA 2 DS 2 -VASc scores (2.8 vs 2.3, p<0.001) and more persistent forms of AF (51 vs 39%, p=0.012). Median changes in the SF-12 physical (3 (25th, 75th: -1, 8) vs 1 (-5, 8), p=0.026) and mental scores (2 (-3, 9) vs 0 (-4, 5), p=0.004), EQ-5D (0 (0,2) vs 0 (-0.1, 0.1), p=0.027) and Karnofsky functional status scores (10 (0, 10) vs 0 (0, 10), p=0.001) were more favourable in patients without recurrent AT/AF. In the overall cohort, the proportion with at least mild cognitive impairment (Montreal Cognitive Assessment <26) declined from 30.3% (n=157) at baseline to 21.8% (n=113) at follow-up. ANCOVA identified greater improvement in Karnofsky functional status (p<0.001) but not SF-12 physical (p=0.238) or mental scores (p=0.065) in those without recurrent AT/AF compared with patients with recurrent AT/AF. Conclusions: Patients without recurrent AT/AF appear to experience greater improvement in functional status but similar QoL as those with recurrent AT/AF after AF ablation. Competing Interests: Competing interests: The study was sponsored by the AF-NET with funding from BMS-Pfizer and the European Union. JPP receives grants for clinical research from Abbott, ARCA biopharma, Boston Scientific, Gilead, Janssen Pharmaceuticals and NHLBI and serves as a consultant to Abbott, Allergan, ARCA Biopharma, Bayer, Biotronik, GSK, Johnson & Johnson, Medtronic, Motif Bio, Sanofi and Phillips. DMT receives speaking honoraria from Boston Scientific, Medtronic and Abbott. KGH reports study grants by Bayer and Sanofi-Aventis, lecture fees/advisory board fees from Sanofi-Aventis, Pfizer, Bristol-Myers-Squibb, Boehringer Ingelheim, Daiichi Sankyo, Edwards Lifesciences, Biotronik and Medtronic. JV reports speaker honoraria from Abbott. PK receives research support for basic, translational and clinical research projects from European Union, British Heart Foundation, Leducq Foundation, Medical Research Council (UK) and German Centre for Cardiovascular Research, from several drug and device companies active in atrial fibrillation and has received honoraria from several such companies in the past. JCN is supported by a grant from the Novo Norvodisk Foundation (NNF16OC0018658). PK is listed as inventor on two patents held by University of Birmingham (Atrial Fibrillation Therapy WO 2015140571, Markers for Atrial Fibrillation WO 2016012783). (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.)
Databáze:	MEDLINE
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