Long-term effects of catheter ablation versus antiarrhythmic drugs on health-related quality of life in patients with atrial fibrillation: the CAPTAF randomized clinical trial revisited

Abstract

Abstract Background Data on long-term effects of catheter ablation versus antiarrhythmic drugs (AAD) on health-related quality of life (HRQoL) and atrial fibrillation (AF) burden are limited. The study aimed to assess long-term HRQoL and rhythm data in symptomatic AF patients. Methods The 75 patients who underwent ablation and 74 receiving AAD in the Catheter Ablation compared with Pharmacological Therapy for Atrial Fibrillation (CAPTAF) trial were followed for 48 months comparison of General Health using 36-Item Short-Form Health Survey, time to first AF-episode ≥1 hour, and AF burden, recorded by implantable cardiac monitors. Results 147 patients completed follow-up, with seven crossovers in the ablation group and 34 crossovers in the AAD group. General Health improved by ablation, median 62 points at baseline to 79.2 points at follow-up (p<0.001), and by AAD from median 67 to 77 points (p<0.001), without treatment differences (p=0.77). Time to first AF-episode ≥1 hour was longer, median 257 days (ablation group) versus 180 days (AAD group), p=0.025. The cumulative AF burden during follow-up was lower in the ablation (median 0.3% [interquartile range 0, 1.4]) versus AAD group (1.6% [0.1, 11.0]), p=0.01. The cumulative reduction in AF burden compared with baseline was greater in the ablation (median -89.5% [-98.4, -51.3]) versus AAD group (-52.7% [-92.6, 263.6]), p=0.001). Conclusions HRQoL improvement at long-term did not differ between ablation and AAD despite a larger reduction in AF burden after ablation. The results should be interpreted in the light of a four times higher crossover rate in the AAD group.