Heartbeat: improved quality of life and reduced healthcare utilisation after catheter ablation in patients with drug-resistant paroxysmal atrial fibrillation

Abstract

The role of catheter ablation of atrial fibrillation (AF) in management of patients with paroxysmal AF is controversial. In this issue of Heart, Gupta and colleagues report data from a multicentre study of 329 consecutive patients with drugrefractory paroxysmal AF treated with AF ablation by pulmonary vein isolation guided by a standardised CLOSE (contiguous optimised lesions) protocol. Patient reported quality of life (QOL) measures showed significant improvement across all domains at 12 months. In addition, QOL improvement was associated with a lower AF burden, measured by ambulatory monitoring. Overall, cardiovascular hospitalisations decreased by 42% after AF ablation. Patients with the lowest QOL measures at baseline had the most improvement after AF ablation (figure 1). In the accompanying editorial, Elvan comments: ‘Significant reduction of the impact of AF on healthcare utilisation and improvement of QOL metrics should be regarded as important and patientrelevant healthcare values gained by catheter ablation of paroxysmal AF. Moreover, Gupta and colleagues report an inverse association between the extent of QOL improvement and residual AF burden postablation. These results emphasise the importance of incorporating AFspecific QOL metrics in AF ablation studies.’ Ongoing innovations in approaches to AF ablation are discussed as well. Identification of predictors of sudden cardiac death (SCD) at the population level are needed for prevention because up to 1⁄2 of events occur in people with no prior history of heart disease. Ågesen and colleagues report the temporal trends in SCD in 14 562 participants followed in the Copenhagen City Heart