Catheter Ablation of Symptomatic Atrial Fibrillation: Impact on Physical Activity, Health-related Quality of Life, and Burden of Arrhythmia
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Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia affecting more than 33 million individuals worldwide. AF may lead to severe complications associated with disabling symptoms that can reduce health-related quality of life (HRQoL) and exercise performance. Catheter ablation (CA) is currently the mainstay of treatment for symptom amelioration and restoration of sinus rhythm (SR) in patients with symptomatic AF. However, despite improvements in HRQoL, it has yet to be elucidated whether functional improvements post-ablation are related to improvements in physical activity and the relation between arrhythmia burden, exercise volume and intensity remains uncertain. Methods: Thirty-six patients with symptomatic paroxysmal or persistent AF undergoing catheter ablation were enrolled. Patients were provided with an accelerometer which recorded and transmitted physical activity over a 7-day period pre- and post-ablation. At baseline and 3-months post-ablation, a 48-hour Holter monitor was performed and a HRQoL survey using the Atrial Fibrillation Effect on QualiTy-of-life (AFEQT) questionnaire was administered. At 3-months, recurrence was assessed using Holter monitoring and HRQoL evaluation was repeated. Results: Within this patient cohort, 28% were female (mean age 60±10). Of the 36 (60%) patients undergoing catheter ablation for their symptomatic AF, 30 (83%) had successful procedures and no recurrent episodes of AF/atrial flutter (AFL) or atrial tachycardia (AT) at 3-months follow-up, while 6 (17%) patients had unsuccessful procedures. Overall, there was an improvement in exercise volume and intensity for all patients who underwent catheter ablation, irrespective of procedural outcome. However, significant improvements in physical activity correlates were only observed in patients with successful procedures (p=0.03 and p=0.013 for total step count and moderate-to-vigorous physical activity (MVPA), respectively) at follow-up. Overall HRQoL at 3-months was substantially increased for patients without recurrences of arrhythmia (p=0.04) and not receiving antiarrhythmic drug (AAD) therapy (p=0.03). AF type had a significant effect on exercise parameters (total step count p=0.005 and MVPA p=0.02) as well as echocardiographic parameters (LVEF p<0.0001) at 3-months post-ablation. Conclusions: Amongst patients with symptomatic paroxysmal or persistent AF, successful treatment with CA led to significant improvements in exercise capacity and HRQoL. Further investigation is warranted to confirm these results in the long-term.