Abstract 2872: Mortality Benefit and Quality of Life Outcomes in Patients Undergoing Curative Ablation for Atrial Fibrillation: Comparison with a Disease-Matched Community Population
Background: While left atrial ablation is highly effective for eliminating atrial fibrillation (AF), the long-term mortality outcomes following radiofrequency ablation (RFA) have remained unclear.
Methods: The study was therefore undertaken to assess mortality outcomes in 731 patients undergoing RFA of AF. These outcomes were compared with disease-matched control population of Olmsted County Minnesota residents. Quality of life (QOL) was assessed with an SF-36 survey at baseline and 3 months and compared to healthy controls.
Results: From 1999–2005, 731 patients (81% male, age 54±11 years) underwent RFA for AF. Of these patients, 154 (21%) had underlying heart disease [77 (11%) coronary artery disease, 19 (3%) heart failure, 25 (3%) hypertrophic cardiomyopathy]. These patients had AF [419(57%) paroxysmal, 310(43%) persistent/permanent] for 6.3±5.9 years. 307 (46%) underwent PV isolation using a lasso-guided approach, 299 (41%) underwent wide area circumferential ablation, while 93 (13%) had a more focal or segmental approach. Over a follow-up of 18±16 months there were 10 deaths. In the community population the mean age was 73±14 years (51% male) and 3428 (74%) had paroxysmal and 1181 (26%) persistent/permanent AF. The 5-year survival was 94% (CI 87–100) after RFA vs. 52% (CI 51–54) in controls, p<0.001. In patients with paroxysmal AF, the 5-year survival was 98% (CI 96–100) after RFA vs. 53% (CI 51–55) in controls, p<0.001. In patients with persistent/permanent AF, the 5-year survival was 85% (CI 65–100) after RFA vs. 50% (47–53%) in controls, p<0.001. After adjustment for age and gender, ablation remained associated with improved survival [HR 0.16 (CI 0.09–0.30), p<0.001]. If the control group was restricted to patients <65 years of age, the survival benefit after RFA persisted [HR 0.10 (0.05–0.19) p<0.001]. All 8 QOL scores normalized to those of the healthy population at 3 months.
Conclusion: These data demonstrate a low long-term mortality rate in ablation patients. The survival with a normal QOL is significantly better in comparison to arrhythmia-matched patients in the community. This information supports prospective clinical trials to assess the overall utility of ablative intervention in patients with ongoing AF.