Mortality, morbidity, and quality of life after circumferential pulmonary vein ablation for atrial fibrillation: outcomes from a controlled nonrandomized long-term study

• Published in: Journal of the American College of Cardiology Vol. 42; no. 2; pp. 185 - 197
• Main Authors: Pappone, Carlo, Rosanio, Salvatore, Augello, Giuseppe, Gallus, Giuseppe, Vicedomini, Gabriele, Mazzone, Patrizio, Gulletta, Simone, Gugliotta, Filippo, Pappone, Alessia, Santinelli, Vincenzo, Tortoriello, Valter, Sala, Simone, Zangrillo, Alberto, Crescenzi, Giuseppe, Benussi, Stefano, Alfieri, Ottavio
• Format: Journal Article
• Language: English
• Published: United States Elsevier Limited 16.07.2003
• Subjects: Aged; Anti-Arrhythmia Agents - therapeutic use; Anticoagulants; Atrial Fibrillation - drug therapy; Atrial Fibrillation - mortality; Atrial Fibrillation - psychology; Atrial Fibrillation - surgery; Cardiac arrhythmia; Cardiology; Cardiovascular disease; Catheter Ablation - adverse effects; Catheter Ablation - methods; Cause of Death; Cerebrovascular Disorders - etiology; Echocardiography, Transesophageal; Family medical history; Female; Follow-Up Studies; Heart attacks; Heart failure; Heart Failure - etiology; Hospitalization; Hospitalization - statistics & numerical data; Humans; Italy - epidemiology; Male; Morbidity; Mortality; Multivariate Analysis; Proportional Hazards Models; Pulmonary Veins - surgery; Quality of Life; Recurrence; Survival Analysis; Time Factors; Treatment Outcome; Italy
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/S0735-1097(03)00577-1

This study was designed to investigate the potential of circumferential pulmonary vein (PV) ablation for atrial fibrillation (AF) to maintain sinus rhythm (SR) over time, thus reducing mortality and morbidity while enhancing quality of life (QoL). Circumferential PV ablation is safe and effective, but the long-term outcomes and its impact on QoL have not been assessed or compared with those for medical therapy. We examined the clinical course of 1,171 consecutive patients with symptomatic AF who were referred to us between January 1998 and March 2001. The 589 ablated patients were compared with the 582 who received antiarrhythmic medications for SR control. The QoL of 109 ablated and 102 medically treated patients was measured with the SF-36 survey. Median follow-up was 900 days (range 161 to 1,508 days). Kaplan-Meier analysis showed observed survival for ablated patients was longer than among patients treated medically (p < 0.001), and not different from that expected for healthy persons of the same gender and calendar year of birth (p = 0.55). Cox proportional-hazards model revealed in the ablation group hazard ratios of 0.46 (95% confidence interval [CI], 0.31 to 0.68; p < 0.001) for all-cause mortality, of 0.45 (95% CI, 0.31 to 0.64; p < 0.001) for morbidities mainly due to heart failure and ischemic cerebrovascular events, and of 0.30 (95% CI, 0.24 to 0.37; p < 0.001) for AF recurrence. Ablated patients' QoL, different from patients treated medically, reached normative levels at six months and remained unchanged at one year. Pulmonary vein ablation improves mortality, morbidity, and QoL as compared with medical therapy. Our findings pave the way for randomized trials to prospect a wider application of ablation therapy for AF.