Radiofrequency Catheter Ablation Improves the Quality of Life Measured with a Short Form-36 Questionnaire in Atrial Fibrillation Patients: A Systematic Review and Meta-Analysis

Yun Gi Kim, Jaemin Shim, Jong-Il Choi, Young-Hoon Kim, Yun Gi Kim, Jaemin Shim, Jong-Il Choi, Young-Hoon Kim

Abstract

Background: The main purpose of performing radiofrequency catheter ablation (RFCA) in atrial fibrillation (AF) patients is to improve the quality of life (QoL) and alleviate AF-related symptoms. We aimed to determine the qualitative and quantitative effects of RFCA on the QoL in AF patients.

Methods: We performed a systemic review and meta-analysis using a random effects model. We searched for the studies that reported the physical component summary score (PCS) and mental component summary score (MCS) of the short form-36, a validated system to assess and quantify the QoL, before and after RFCA in AF patients. PCS and MCS are T-scores with a mean of 50 and standard deviation of 10.

Results: Of the 470 studies identified through systematic search, we included 13 studies for pre-RFCA vs. the post-RFCA analysis and 5 studies for treatment success vs. AF recurrence analyses. In the pre-RFCA vs. post-RFCA analysis, RFCA was associated with a significant increase in both the PCS (weighted mean difference [WMD] = 6.33 [4.81-7.84]; p < 0.001) and MCS (WMD = 7.80 [6.15-9.44]; p < 0.001). The ΔPCS (post-RFCA PCS-pre-RFCA PCS) and ΔMCS values were used for the treatment success vs. AF recurrence analysis. Patients with successful ablation had a higher ΔPCS (WMD = 7.46 [4.44-10.49]; p < 0.001) and ΔMCS (WMD = 7.59 [4.94-10.24]; p < 0.001).

Conclusions: RFCA is associated with a significant increase in the PCS and MCS in AF patients. Patients without AF recurrence after RFCA had a better improvement in the PCS and MCS than patients who had AF recurrence.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Study selection process.
Fig 1. Study selection process.
The flow diagram is depicted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. AF: atrial fibrillation; SF-36: short form-36; RFCA: radiofrequency catheter ablation.
Fig 2. Forest plots: pre-RFCA vs. post-RFCA.
Fig 2. Forest plots: pre-RFCA vs. post-RFCA.
The pooled WMD of PCS (A) and MCS (B) are presented. The size of the black squares corresponds to the weight of each study included. The overall effect size was calculated with a random effects model. The raw data extracted from each study are described in Table 3. CI: confidence intervals; MCS: mental component summary score; PCS: physical component summary score; RFCA: radiofrequency catheter ablation; WMD: weighted mean difference.
Fig 3. Funnel plots: pre-RFCA vs. post-RFCA.
Fig 3. Funnel plots: pre-RFCA vs. post-RFCA.
Possible missing studies are imputed in addition to the original studies to adjust for the possible publication bias. The results of the trim and filled WMD of PCS (A) and MCS (B) are presented. MCS: mental component summary score; PCS: physical component summary score; WMD: weighted mean difference.
Fig 4. Subgroup analysis according to the…
Fig 4. Subgroup analysis according to the treatment success rate.
Studies that reported a treatment success rate over 70% showed a trend toward a better improvement in the PCS (A) and a significantly better improvement in the MCS (B). CI: confidence intervals; MCS: mental component summary score; PCS: physical component summary score; RFCA: radiofrequency catheter ablation.
Fig 5. Forest plots: treatment success vs.…
Fig 5. Forest plots: treatment success vs. AF recurrence.
The pooled WMD of ΔPCS (A) and ΔMCS (B) are presented. The size of the black squares corresponds to the weight of each study included. The overall effect size was calculated with a random effects model. The raw data extracted from each study are described in Table 4. AF: atrial fibrillation; CI: confidence intervals; MCS: mental component summary score; PCS: physical component summary score; WMD: weighted mean difference.
Fig 6. Funnel plots: treatment success vs.…
Fig 6. Funnel plots: treatment success vs. AF recurrence.
A visual asymmetry was suspected in the funnel plot analysis of the ΔPCS (A) and ΔMCS (B). After applying the trim and fill method, possible missing studies were imputed. Original and adjusted WMDs are presented. AF: atrial fibrillation; MCS: mental component summary score; PCS: physical component summary score; WMD: weighted mean difference.

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