Page 33 - ADD-ON ABLATION SURGERY IN PATIENTS WITH ATRIAL FIBRILLATION

Introduction
Chronic or paroxysmal atrial fibrillation (AF) is the most common arrhythmia
in patients undergoing valvular or coronary surgery (5-40%), depending on the
underlying disease and age. Historically long-term treatment for symptomatic 2 AF consists of comprising pharmacological treatment 1 and the ‘ablate and pace
strategy’1-3. More definite treatment strategies, such as pulmonary vein (PV)
isolation and limited left atrial ablation techniques (add-on surgery) have become
the focus of current investigations. From 1948 onwards, when the World Health
Organisation defined health as not only the absence of disease, but also as the
presence of physical, mental and social well-being, health-related quality of life
(HrQoL) has become an important parameter in studies evaluating new therapies4.
Although the definition of HrQoL may vary, there is an emerging consensus that
quality of life can be assessed on four domains5,6: physical condition, psychological
well-being, social activities and every daily activity. Randomised controlled trials
as the PIAF, RACE and AFFIRM have examined the impact of rate versus rhythm-
control strategies on HrQoL and showed that inducing chronic sinus rhythm (SR)
is not necessarily associated with an enhanced HrQoL7-9. One drawback of the
above studies is the fact that chronic SR is difficult to obtain, as only 30 to 50% of
the patients were in SR at the end of follow-up. By contrast, arrhythmia surgery is
considered highly effective in restoring SR.Although improved HrQoL is one of
the primary aims of add-on arrhythmia surgery, reports on successful treatment
of AF are usually small non-randomised or non-controlled cohort studies with
short follow-up periods and non-standardized evaluation of rhythm outcome
at the end of follow-up.This study is the first multicentre randomized trial that
compares the effect of add-on epicardial PV isolation and standard surgery on
HrQoL in patients with paroxysmal, as well as permanent and persistent AF
during one-year follow-up with standardized rhythm evaluation. The objective
of this study was to evaluate the effects of add-on arrhythmia surgery up till
one year postoperatively on HrQoL, compared to patients who received only
standard cardiac surgery.
Quality of life after cardiac surgery
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