Page 41 - ADD-ON ABLATION SURGERY IN PATIENTS WITH ATRIAL FIBRILLATION

explained by raised levels of anxiety or depression. Finally, fatigue is a common
symptom in patients with valve disease and/or coronary artery disease; on the
other hand fatigue is also a key symptom of AF. The MFI-20 scores revealed an
overall reduction in perceived dimensions of fatigue, probably due to treatment
of underlying heart disease instead of diminishing the prevalence of AF. In general 2 this prospective randomised study reveals that successful cardiac surgery is a
predictor for improvement in HrQoL in patients with paroxysmal AF as well as in patients with chronic AF. Add-on surgery did not significantly contribute to rhythm conversion and HrQoL measurements improved equally for both treatment groups. It is suggested that in this population, impaired HrQoL was predominantly caused by pre-operative underlying heart disease and not by AF.
Comparison with previous studies
Recent studies (RACE and AFFIRM) show that restoration of SR in AF patients has no effect on mortality or on major physical endpoints,which therefore would imply no benefit in attempted restoration of SR, if survival or complications alone is the reason for rate/rhythm drug therapy7,14.This trial confirms that add-on surgery does not have any significant benefit on morbidity and mortality. Furthermore, patients who did not convert to SR after cardiac surgery perceived sufficient rate and rhythm control (cardioversions and antiarrhythmic drugs) and therefore did not show an inter-group difference in HrQoL outcome. This is consistent with above-mentioned studies (no differences in rate versus rhythm-control on HrQoL). However, improvement in HrQoL is one of the most important reasons to treat patients with AF today, though it is highly dependant on the selected add-on surgery procedure30.This study also showed an improvement in HrQoL if the ablation surgery was unsuccessful, although it was not statistically significant; probably patients who undergo a prolonged invasive procedure would have some QoL benefit from the procedure itself, unrelated to the presence or absence of AF. In the study by Gerstenfeld et al.1 focal AF ablation was pursued in 41 patients, with QoL evaluation by modified SF-36. The ablation success rate was 32% with a coinciding significant improvement in HrQoL also after AF recurrence, suggesting that the ablation modified the AF substrate without complete elimination of the AF burden. A recent study of Weerasooriya et al.32 showed a combined PV isolation and linear atrial ablation technique, with a success rate of 86% in 63 patients with paroxysmal AF during a 12-month follow- up. Successful ablation showed a significant improvement for all eight sub-scales of
Quality of life after cardiac surgery
49