Changes in quality of life, cognition and functional status following catheter ablation of atrial fibrillation.
Changes in quality of life, cognition and functional status following catheter ablation of atrial fibrillation.
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DOI：
10.1136/heartjnl-2020-316612
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发表时间：
2020-12
期刊：
影响因子：
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通讯作者：
Kirchhof P
中科院分区：
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作者：
Piccini JP;Todd DM;Massaro T;Lougee A;Haeusler KG;Blank B;de Bono JP;Callans DJ;Elvan A;Fetsch T;Van Gelder I;Gentlesk P;Grimaldi M;Hansen J;Hindricks G;Al-Khalidi H;Mont L;Nielsen JC;Noelker G;De Potter T;Scherr D;Schotten U;Themistoclakis S;Vijgen J;Di Biase L;Kirchhof P
探讨房颤（AF）消融术后心律失常复发对生活质量（QoL）、认知和功能状态的影响。我们在AXAFA-AFNET 5临床试验中比较了复发性房性心动过速（AT）/AF患者与未复发性AT/AF患者的生活质量、认知和功能状态。我们还试图通过有和没有协方差分析（ANCOVA）的总体变化评分来确定与房颤消融术后生活质量和功能状态改善相关的因素。在518例接受AF消融的患者中，154例（29.7%）在3个月时复发AT/AF。复发性AT/AF患者的平均CHA2DS2-VASc评分更高（2.8 vs 2.3，p <0.001），AF的持续性更高（51 vs 39%，p = 0.012）。SF-12体格检查的中位变化（3（25日、75日：-1，8）vs 1（-5，8），p = 0.026）和心理评分（2（− 3，9）vs 0（− 4，5），p = 0.004），EQ-5D（0（0，2）vs 0（-0.1，0.1），p = 0.027）和Karnofsky功能状态评分（10（0，10）vs 0（0，10），p = 0.001）在未复发AT/AF的患者中更有利。在整个队列中，至少有轻度认知障碍（蒙特利尔认知评估<26）的比例从基线时的30.3%（n = 157）下降到随访时的21.8%（n = 113）。ANCOVA发现，与复发性AT/AF患者相比，无复发性AT/AF患者的Karnofsky功能状态改善更大（p <0.001），但SF-12身体评分（p = 0.238）或精神评分（p = 0.065）没有改善。AF消融术后，无复发性AT/AF患者的功能状态改善更大，但生活质量与复发性AT/AF患者相似。
To investigate changes in quality of life (QoL), cognition and functional status according to arrhythmia recurrence after atrial fibrillation (AF) ablation. 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). 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 CHA2DS2-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. 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.