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Catheter Ablation: Long-Term A-Fib Symptom Reduction and Improved Quality of Life
In an observational study from Sweden, researchers examined the long-term effects of catheter ablation after 5 years. They wanted to know if undergoing a catheter ablation would affect both A-Fib symptoms and health-related Quality of Life (HRQoL).
Catheter Ablation: Eliminated or Reduced A-Fib Symptoms
From 2011 through 2019, 1521 A-Fib patients had RF PVI catheter ablations at Swedish hospitals using primarily the Carto system. After 5 years, 52% reported freedom from symptoms, 18% reported a greater than 50% symptom reduction, 14% had a minor reduction, while 18% reported no effect or a worsening of symptoms. Over half of the patients who had a catheter ablation were free from arrhythmia-related symptoms.
Symptom Reduction: Of those A-Fib patients still reporting symptoms, more than 80% experienced a symptom reduction. Altogether, more than 80% of the study participants experienced an improved arrhythmia-related situation. Researchers wrote: “The positive effect of CA [catheter ablation] on symptoms is long-lasting.”
Re-Ablation Option: Some of those who did not improve or whose symptoms worsened were accepted for re-ablation at follow-up. After five years, the most commonly reported symptoms were: breathlessness during activity, weakness/fatigue, and tiredness.
Independent predictors: Of those who reported no or worse A-Fib effects at follow-up, independent predictors were:
• Female gender
• Obesity (Body mass index ≥ 35)
• Ischemic Heart Disease (IHD) (narrowed arteries).
At follow-up in the study, the researchers didn’t find any gender differences.
More About Women with A-Fib: In my article, Women with A-Fib: Mother Nature and Gender Bias, I discuss how women have a higher symptom burden and often experience a more negative Quality of Life.
Dramatic Improvement in Quality of Life After Catheter Ablation
Quality of life (HRQoL) was evaluated both before the catheter ablation and after 5 years.
I found the Quality of Life questionnaire (ASTA) to be comprehensive, well written, and easy for patients to fill out.
Patients reported Quality of Life by using a 13-item scale divided into a 7-item physical subscale and a 6-item mental subscale. (HRQoL scale score values ranged from 0 to 100. Higher scores reflected both a higher symptom burden and a worse effect on Quality of Life.)
Quality of Life score was significantly lower [better] 5 years after catheter ablation (36.7 vs 13.1).
Quality of Life was obviously influenced by A-Fib symptoms which can cause psychological and emotional effects. At baseline at the beginning of the study, the most commonly reported negative influences on Quality of Life (HRQoL) were physically related: impaired physical ability, deteriorated life situation, and feeling unable to carry out daily activities.
Patients also reported worry, uncertainty about potential side-effects of medication, risk of recurrence, and the possible need for repeat procedures.
These negative effects improved dramatically over five years. The negative influences on HRQoL were primarily in those still reporting the presence of arrhythmia.
The Elderly had the Same Improvement as Younger Patients
Older A-Fib patients (over age 75) reported the same significant improvement in the symptoms scale score as younger ones. Quality of Life (HRQoL) improved significantly over 5 years, without any differences found between gender or age group.
Editor’s Comments:
Being “Elderly” Shouldn’t Stop You from Having a Catheter Ablation: Unfortunately, some centers have an age cutoff for catheter ablation at age 75 or 80. This Swedish study instead found that “patients with AF should not be excluded from CA solely because of age.” To learn more see my FAQs A-Fib Ablations: Is 82 Too Old for a PVA?
Catheter Ablation Produces Better Results Today: A-Fib is one of the easiest heart diseases to “cure”. Catheter Ablation (CA) today is one of the safest, most effective, life-transforming procedures you can have in a hospital (CA isn’t surgery, there is no cutting involved.)
Today’s advanced catheter ablation treatments and mapping would probably produce greater symptom reduction than in this study.
Important Study on Quality of Life: The authors are to be commended for studying how catheter ablation influences Quality of Life (HRQoL). (Anyone who has become A-Fib free can testify how transformative and life-changing it is to go from A-Fib to normal sinus rhythm, such as myself.)
For many A-Fib patients, the impact on Quality of Life is just as important as their symptoms.
When doctors talk with patients about catheter ablation, they usually concentrate on A-Fib symptoms.
Instead, more emphasis should be put on how catheter ablation can radically improve Quality of Life. In this Swedish study, the strongest, most dramatic results for patients were in improved Quality of Life.
For many A-Fib patients, the challenges and impact on Quality of Life are just as important as their symptoms.
Considering a catheter ablation for your Atrial Fibrillation? Learn more on our Treatments for A-Fib page: Catheter Ablation: Pulmonary Vein Ablation (Isolation)
