A comparison of the real world effectiveness of catheter ablation and drug therapy in atrial fibrillation patients in a Chinese setting

Xin Du, Lizhu Guo, Xiaonan He, Yu Jia, Jiahui Wu, Deyong Long, Ronghui Yu, Caihua Sang, Xiaohui Liu, Hongjun Yin, Jianwei Xuan, Jianzeng Dong, Changsheng Ma, Xin Du, Lizhu Guo, Xiaonan He, Yu Jia, Jiahui Wu, Deyong Long, Ronghui Yu, Caihua Sang, Xiaohui Liu, Hongjun Yin, Jianwei Xuan, Jianzeng Dong, Changsheng Ma

Abstract

Background: Studies have demonstrated that catheter ablation of atrial fibrillation is associated with better rhythm control than drug therapy. The present study aimed to assess the clinical outcomes and health-related quality of life of ablation therapy in a real world setting.

Methods: A prospective, non-randomized, single center study in a real-world clinical setting in China was conducted. Patients were followed up at 3, 6, and 9 months after baseline encounter. Propensity score matched patients receiving ablation or anti-arrhythmic drug therapy were compared. Incidence rate of atrial fibrillation recurrence and quality of life outcomes were measured and analyzed using log-rank test, multivariate logistic regression and mixed-effects linear regression respectively.

Results: In this study, 151 atrial fibrillation patients treated by ablation therapy and 318 patients treated by anti-arrhythmic drugs were enrolled. During follow up, 82.0% in the ablation arm and 22.4% in the drug arm had no documented atrial fibrillation recurrence [HR for atrial fibrillation recurrence 0.07 (95%CI: 0.02-0.21, p < 0.0001)] among paroxysmal atrial fibrillation patients. The corresponding no recurrent rate were 66.7% and 18.5% [0.21 (0.05-0.95, p = 0.04)] respectively among persistent atrial fibrillation patients. Improvement in Short Form-36 physical component scores, Short Form-36 mental component scores and total Atrial Fibrillation Effect on Quality-of-life scores were 16.33 (14.05-18.61, p < 0.001), 8.10 (6.11-10.09, p < 0.001) and 18.28 (16.11-20.45, p < 0.001) respectively among paroxysmal AF patients and 6.32 (3.15-9.49, p < 0.001), 3.99 (1.82-6.16, p < 0.001) and 13.97 (10.89-17.05, p < 0.001) respectively among persistent AF patients. Improvements in total Atrial Fibrillation Effect on Quality-of-life score were also significant in ablation arm while no significant improvement of total Atrial Fibrillation Effect on Quality-of-life score in the drug arm.

Conclusion: Compared with drug therapy, catheter ablation is associated with significant lower AF recurrence and improved overall quality of life.

Trial registration: The present study has been registered on clinicaltrials.gov. The ClinicalTrials.gov ID is NCT01878981 . The registration date is May 29, 2013.

Keywords: Anti-arrhythmic drugs; Atrial fibrillation; Catheter ablation; Chinese; Quality of life.

Conflict of interest statement

Ethics approval and consent to participate

The study was approved by the Ethics Committee of Anzhen Hospital and informed consent was obtained in writing from the patients included.

Consent for publication

All authors listed have given consent for publication of the manuscript. By signing the consent form, patients have given consent for publication of aggredate data, which do not include individual data or image.

Competing interests

Changsheng Ma has support from Johnson & Johnson, Bristol-Myers Squibb, Pfizer, Boehringer-ingelheim for the submitted work; (2) Yu Jia is an employee of Johnson & Johnson Medical (China). No author has non-financial interests that may be relevant to the submitted work.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flowchart of Patient Selection. Abbreviations: AAD: antiarrhythmia drugs; AF: atrial fibrillation; PA: propensity score
Fig. 2
Fig. 2
Rates of AF recurrence in the ablation and drug arms * p ≤ 0.05. a Before matching. b After matching
Fig. 3
Fig. 3
Freedom from Documented AF/AFL/AT Recurrences with Failure Modes for Matched Patients. a Paroxysmal AF patients. b Persistent AF Patients
Fig. 4
Fig. 4
Change in SF-36 Physical and Mental Component Scores among the Ablation and Drug Patients. PCS stands for Physical Component Score. MCS stands for Mental Component Score. * p ≤ 0.05
Fig. 5
Fig. 5
Change in AFEQT Total and Subscale Scores among the Ablation and Drug Patients * p ≤ 0.05

References

    1. Benjamin EJ, Wolf PA, D’Agostino RB, Silbershatz H, Kannel WB, Levy D. Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. Circulation. 1998;98:946–952. doi: 10.1161/01.CIR.98.10.946.
    1. Andersson T, Magnuson A, Bryngelsson IL, Frobert O, Henriksson KM, Edvardsson N, Poci D. All-cause mortality in 272,186 patients hospitalized with incident atrial fibrillation 1995–2008: a Swedish nationwide long-term case control study. Eur Heart J. 2013;34:1061–1067. doi: 10.1093/eurheartj/ehs469.
    1. Ynsaurriaga FA, Peinado RP, Ormaetxe Merodio JM. Atrial fibrillation and quality of life related to disease and treatment: focus on anticoagulation. Futur Cardiol. 2014;10:381–393. doi: 10.2217/fca.14.13.
    1. Mont L, Bisbal F, Hernández-Madrid A, Pérez-Castellano N, Viñolas X, Arenal A, et al. SARA investigators. Catheter ablation vs. antiarrhythmic drug treatment of persistent atrial fibrillation: a multicentre, randomized, controlled trial (SARA study) Eur Heart J. 2014;35:501–507. doi: 10.1093/eurheartj/eht457.
    1. Morillo CA, Verma A, Connolly SJ, Kuck KH, Nair GM, Champagne J, Sterns LD, Beresh H, Healey JS, Natale A. RAAFT-2 Investigators.Radiofrequency ablation vs antiarrhythmic drugs as first-line treatment of paroxysmal atrial fibrillation (RAAFT-2): a randomized trial. JAMA. 2014;311:692–700. doi: 10.1001/jama.2014.467.
    1. Biviano AB, Hunter TD, Dandamudi G, Fishel RS, Gidney B, Herweg B, Oza SR, Patel AM, Wang H, Pollak SJ. Healthcare Utilization and Quality of Life Improvement after Ablation for Paroxysmal AF in Younger and Older Patients. Pacing Clin Electrophysiol. 2017;40:391–400. doi: 10.1111/pace.13041.
    1. Ferrari R, Bertini M, Blomstrom-Lundqvist C, Dobrev D, Kirchhof P, Pappone C, Ravens U, Tamargo J, Tavazzi L, Vicedomini GG. An update on atrial fibrillation in 2014: From pathophysiology to treatment. Int J Cardiol. 2016;203:22–29. doi: 10.1016/j.ijcard.2015.10.089.
    1. Sullivan M, Karlsson J, Ware JE., Jr The Swedish SF-36 Health Survey—I. Evaluation of data quality, scaling assumptions, reliability and construct validity across general populations in Sweden. Soc Sci Med. 1995;41:1349–1358. doi: 10.1016/0277-9536(95)00125-Q.
    1. Spertus J, Dorian P, Bubien R, Lewis S, Godejohn D, Reynolds MR, et al. Development and validation of the Atrial Fibrillation Effect on QualiTy-of-Life (AFEQT) Questionnaire in patients with atrial fibrillation. Circ Arrhythm Electrophysiol. 2011;4:15–25. doi: 10.1161/CIRCEP.110.958033.
    1. Lee ET. Statistical Methods for Survival Data Analysis. Belmont: Lifetime Learning Publications; 1980.
    1. Cox D. Regression models and life tables. J R Stat Soc Ser B. 1972;34:187–203.
    1. Cox D. Partial likelihood. Biometrika. 1975;62:269–276. doi: 10.1093/biomet/62.2.269.
    1. Hedeker D, Gibbons RD. Longitudinal Data Analysis. Hoboken: John Wiley & Sons; 2006.
    1. Calkins H, Reynolds MR, Spector P, Sondhi M, Xu Y, Martin A, et al. Treatment of atrial fibrillation with antiarrhythmic drugs or radiofrequency ablation: two systematic literature reviews and meta-analyses. Circ Arrhythm Electrophysiol. 2009;2:349–361. doi: 10.1161/CIRCEP.108.824789.

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