Atrial fibrillation (AF) is the most common arrhythmia seen in clinical practice. Previous studies have demonstrated that AF may result in high symptom burden and reduced quality of life (QoL). Rhythm control in the form of catheter ablation has become an established treatment option for AF. Certain risk factors are associated with the development and progression of AF, notably, an elevated body mass index (BMI). Emerging evidence suggests that risk factor modification in the management of AF is an important component of the patient pathway. Previous studies concerning the influence of a raised BMI on patient-reported outcomes after ablation have been contradictory. Qualitative research in this area has been limited.
Aim: This study aimed to explore the quality of life, symptoms, and experiences in patients with an elevated BMI undergoing catheter ablation for AF.
Methods: This was a single centre, mixed methods cohort observational study of patients with a BMI >=25 who were eligible for first-time AF ablation. All eligible patients over a 9-month period were invited to take part. Quality of life and symptoms were assessed before ablation and at 3 and 6 months afterwards, using the SF-36 and Patient Perception Questionnaire, which are both validated tools previously used in this patient population. Multiple regression models were used to identify predictors for improvements in two of the QoL domains (vitality and general health) after ablation. Independent variables which included age, gender, BMI at baseline, classification of AF, left atrial volume index and rhythm control at 6 months were added to the regression model. At 6 months post-ablation semi-structured interviews were undertaken to establish the patient experiences in this context.
Results: Eighty-eight invited patients agreed to take part and 82 of those completed the study. The 6 that were excluded had left atrial appendage thrombus on the day of the ablation or did not complete follow-up. A significant improvement was seen in all domains of quality of life after ablation (p<0.0005). Symptom-burden also significantly improved at 3 and 6 months after ablation (p<0.0005). Multiple regression analysis demonstrated the only predictor of improved vitality and general health in QoL measures was rhythm control at 6 months. Thematic analysis of participants experiences revealed 4 themes: personal well-being related to AF, care and treatments of AF, interplay of lifestyle and AF and living with AF in a pandemic.
Conclusion: This study has demonstrated that, despite a raised BMI, patients report significant QoL and symptomatic improvements after AF ablation. Furthermore, in this cohort a multiple regression analysis demonstrated that it is rhythm control at 6 months that predicts improvements in vitality and general health components of the SF-36. Patient experiences commonly include personal well-being related to AF, care and treatments of AF, interplay of lifestyle and AF and living with AF in a pandemic. Overall, this study suggests that patients with a raised BMI have positive outcomes after catheter ablation for AF and that rhythm control is the most important factor of improved quality of life. Furthermore, patient experiences of the AF diagnosis are challenging, ablation treatment is positive and lifestyle factors play an important role in looking to the future. ❑
