Boersma, A.M. (2020) Major quality of life improvement after cryoballoon ablation in patients with persistent atrial fibrillation: an observational, single-centre study over 5 years of follow up (CRYOPERS-QOL). thesis, Medicine.
Full text available on request.Abstract
BACKGROUND: Atrial fibrillation (AF) is the most common cardiac arrhythmia worldwide. Health consequences and impact on everyday life are considerable. Although there is no consensus on superiority of either rate- or rhythm control as treatment strategy on reducing mortality or morbidity, in highly symptomatic patients, rhythm control is strongly indicated. Pulmonary Vein Isolation (PVI) has shown to be effective in improving quality of life (QoL) and preventing recurrences in paroxysmal AF. However, data on long term outcomes in patients with persistent AF are lacking. METHODS: This semi retrospective cross-sectional study consists of 150 patients with persistent AF who underwent cryo-PVI between 2013-2017. Primary endpoint was QoL determined by the AF-specific functional mEHRA-classification. Secondary endpoints were procedural safety, efficacy in prevention of recurrence events, impact of recurrences on QoL and identification of patient factors associated with QoL. Follow up period ranged from 2-5 years. RESULTS: mEHRA-class improved in 82.5% of patients, changing median symptom-class from III ‘Severe’ at baseline, to I ‘None’ after ablation, a significant result (p <0.001). AF-recurrence events (registered episode >30sec) were observed in 46.8% of patients. Patients with AF-recurrence vs. patients without AF-recurrence, scored significantly lower on the Atrial Fibrillation Effect on QualiTy-of-Life (AFEQT)-questionnaire, 78.1 vs. 94.1, respectively (p= <0.001). Major complications were seen in 0.8% of patients, none of which caused long term consequences. CONCLUSIONS: Cryoablation is associated with a major QoL improvement, whilst being a safe method in effectively reducing AF-recurrence, and is therefore recommended in highly symptomatic, persistent AF patients. More evidence from RCTs is required to provide a first-line treatment indication for all persistent AF patients. Additionally, our study demonstrated feasibility and clinical relevance of the use of patient-satisfaction driven outcomes in CA-trials, since the indication for CA is symptom-based.
| Item Type: | Thesis (UNSPECIFIED) |
|---|---|
| Supervisor name: | de Jong, J.S.S.G. and Mol, D. and Aanhaanen, W.T.J. |
| Faculty: | Medical Sciences |
| Date Deposited: | 22 Aug 2023 11:09 |
| Last Modified: | 22 Aug 2023 11:09 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/3643 |
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