Abstract 9219: More Extensive Ablation in Addition to Pulmonary Vein Isolation Can Improve Quality of Life in Elderly Patients With Persistent Atrial Fibrillation: Insights from the Earnest-pvi Trial

Abstract

Introduction: Improving the quality of life (QoL) is one of the main purposes of catheter ablation of persistent atrial fibrillation (AF). QoL improvement in persistent AF patients has not been fully clarified. The EARNEST-PVI trial was a multi-center randomized trial comparing clinical outcomes of pulmonary vein isolation (PVI) alone and more intensive ablation in addition to PVI including complex fractionated atrial electrogram (CFAE) and linear ablation (PVI plus). Objective: To investigate the QoL changes after persistent AF ablation and the differences between the PVI-alone strategy and the PVI plus strategy in elderly and non-elderly patients. Methods: In the EARNEST-PVI trial, patients with persistent AF who underwent an initial catheter ablation (n = 512) were randomly assigned in a 1:1 ratio to either PVI alone or PVI plus. Quality of life was assessed at baseline and at 12 months after ablation for AF using the 36-Item Short Form Health Survey. Scores were also converted to a physical health component summary (PCS), a mental health component summary (MCS) and a role/social component summary (RCS). Results: After excluding 68 patients for whom preoperative or postoperative QoL assessment was not available, 444 patients were divided into two groups: those 65 years old and over and those under 65 years old, and assessed whether there was a difference in QoL improvement between the ablation strategies. In non-elderly patients, although there was improvement in all aspects of QoL after ablation, there was no difference between strategies. In contrast, the improvement in PCS was significantly greater in elderly patients who underwent PVI-plus. (PVI group 0.8 ± 10.3 vs. PVI-Plus group 3.8 ± 11.2, P=0.021) Conclusions: While ablation for persistent AF improved QoL regardless of strategy, more extensive ablation in addition to PVI could improve QoL in the elderly patients.