Long-term quality of life after ablation of atrial fibrillation the impact of recurrence, symptom relief, and placebo effect

We sought to determine the relationship between atrial fibrillation (AF) ablation efficacy, quality of life (QoL), and AF-specific symptoms at 2 years. Although the primary goal of AF ablation is QoL improvement, this effect has yet to be demonstrated in the long term. A total of 502 symptomatic AF ablation recipients were prospectively followed for recurrence, QoL, and AF symptoms. In 323 patients with 2 years of follow-up, 72% achieved AF elimination off antiarrhythmic drugs (AADs), 15% achieved AF control with AADs, and 13% had recurrent AF. The physical component summary scores of the Medical Outcomes Study Short Form 36 increased from 58.8 +/- 20.1 to 76.2 +/- 19.2 (p < 0.001) and the mental component summary scores of the Short Form 36 increased from 65.3 +/- 18.6 to 79.8 +/- 15.8 (p < 0.001). Post-ablation QoL improvements were noted across ablation outcomes, including recurrent AF (change in physical component summary: 12.1 +/- 19.7 and change in mental component summary: 9.7 +/- 17.9), with no significant differences in QoL improvement across 3 ablative efficacy outcomes. However, in 103 patients who completed additional assessment with Mayo AF Symptom Inventories (on a scale of 0 to 48), those with AF elimination off AADs had a change in AF symptom frequency score of -9.5 +/- 6.3, which was significantly higher than those with AF controlled with AADs (-5.6 +/- 3.8, p = 0.03) or those with recurrent AF (-3.4 +/- 8.4, p = 0.02). Independent predictors of limited QoL improvement included higher baseline QoL, obesity, and warfarin use at follow-up. AF ablation produces sustained QoL improvement at 2 years in patients with and without recurrence. AF-specific symptom assessment more accurately reflects ablative efficacy.