Significant improvement in HRQoL has been documented using general and specific questionnaires for this form of AF therapy [6, 28, 29]. Bubien et al. used four questionnaires to measure HRQoL: SF-36, SCL, Perceived Impact of the Arrhythmia on Activities of Daily Living, and Performance of Activities of Daily Living [6]. Patients who had ablation with subsequent pacemaker implantation noted significant improvement in all dimensions of the SF-36 with the exception of general self-rated health.

A meta-analysis containing 21 studies and involving 1,181 patients with drugrefractory AF examined the effect of radiofrequency (RF) ablation and pacing therapy on HRQoL. The results demonstrated a significant improvement in HRQoL after the procedure [30].

A systematic review by Thrall et al. suggested that adjunctive pharmacological therapy did not appear to confer additional benefit on HRQoL over ablate and pace procedures alone. The significant improvement in HRQoL demonstrated after ablate and pace procedures may be explained by the marked symptomatic relief such treatment provides [31].

Similar results were found in a study of patients after isolation of pulmonary veins or the Maze procedure. This created an “anatomical barrier” for the conduction and diffusion of arrhythmia [32]. In these patients, besides questions concerning pain, significant improvement was noted in the remaining dimensions of the SF-36, especially with respect to physical and psychological activity.

The Ablate and Pace Trial (APT) noted improvement in HRQoL measured using the Health Status Questionnaire, Quality of Life Index Cardiac Version III, and SCL [28]. Only a select group of patients with difficult-to-control AF attacks participated in this study, so the results could not be generalized for all AF patients. This point is worth remembering if analyzing the results of HRQoL studies comparing patients treated with ablation of the AV junction with pacemaker implantation versus those treated by pharmacological means to control ventricular rhythm.

There have been many studies on several techniques that apply RF ablation to treat AF [33–37]. Pappone et al. compared ablation in the area of the pulmonary veins with pharmacological treatment involving control of ventricular rhythm [33]. HRQoL was measured using SF-36 at baseline and every 3 months over 1 year. This study found ablation therapy improved HRQoL whereas antiarrhythmic drugs (i.e., amiodarone, propafenone, sotalol), though effective in controlling ventricular rhythm, did not improve HRQoL.

Using SF-36 and a questionnaire examining symptoms, Gernstenfeld et al. studied 41 patients considered for ablation in the area of the pulmonary veins [34]. Eleven underwent electrophysiologic testing without ablation; 18 had ablation and recurring AF; and 12 had a successful RF ablation.

The greatest improvement in HRQoL was reported by patients after successful ablation, whereas a trend towards improvement, though not as significant, was also noted in patients with recurrent AF after ablation. Other selected available studies are shown in Table 6.2.

A degree of caution is needed when interpreting the HRQoL outcomes available for ablation studies. It appears that some of the symptomatic benefit of ablation is not due to control of the rhythm because investigators have shown an increase in the frequency of asymptomatic AF after ablation [38, 39]. There is also a great potential for placebo and non-placebo effects based on the subjective nature of HRQoL endpoints and the lack of blinding in these studies. It has been shown that invasive cardiac procedures, even under “sham” conditions, can improve patient reported wellbeing [39]. Despite these limitations, catheter ablation for AF appears to be more effective than drugs for rhythm control, and available data suggest that successful procedures are associated with large improvements in HRQoL in highly symptomatic patients.

The Maze procedure is the best known surgical method of AF treatment [32]. This procedure, because of its invasive character, is sometimes used as an additional procedure, especially in patients with valvular heart disease. Lönnerholm et al. studied patients with lone AF, which constituted 80% of the general sample, as candidates for this procedure [32]. HRQoL was measured using SF-36 before surgery as well as 6 months and 12 months thereafter. The study involved 48 patients who underwent the Maze procedure. Sinus rhythm was restored and maintained in 90% of patients after 6 months of observation. After the procedure, HRQoL improved across all dimensions of the SF-36 with the exception of pain. Six and 12 months after the procedure, HRQoL reached an age-appropriate level characteristic for the general population.

Jessurun et al. studied patients with symptomatic, lone AF resistant to pharmacotherapy treated using the Maze procedure, whereas HRQoL was measured using SF-36 [40]. After this procedure, patients also noted significant improvement in HRQoL.

Improving QoL is one of the main therapeutic goals in the treatment of supraventricular tachycardia (SVT), atrioventricular nodal reentrant tachycardia (AVNRT), and atrioventricular reentrant tachycardia (AVRT). RF ablation and pharmacotherapy have been proposed as effective treatment strategies. There have been few studies examining to what extent these two strategies differ in their influence on HRQoL.

Previous studies reported that RF ablation improves HRQoL in patients with SVT [6, 41]. Lau et al. examined SVT patients with an additional accessory pathway subject to RF ablation after 3 months of antiarrhythmic therapy [41]. QoL was measured using the General Health Questionnaire, Somatic Symptoms Inventory and Sickness Impact Profile. After RF ablation, improvement in HRQoL was maintained for 1 year of follow-up, and patients observed increased exercise tolerance.

The extent of improvement in HRQoL varied between patients according to the severity of arrhythmia. This observational study was, however, limited to patients with severe symptoms or those who have had undergone previous antiarrhythmic therapy.

A subsequent study [42] compared the influence of RF ablation and pharmacotherapy on the HRQoL of SVT patients. Both strategies improved HRQoL and decreased the frequency of symptoms. However, compared with pharmacotherapy, ablation decreased the frequency of symptoms in more patients (i.e., 74% versus 33%).

In another prospective study, Goldberg et al. [43] compared the long-term influence of RF ablation and pharmacotherapy as initial forms of therapy in 83 patients with newly diagnosed acute SVT (AVNRT 67%; AVRT 28%). HRQoL was measured using SF-36. Improved HRQoL was confirmed in both groups after 1 year. During this time, significant improvement in physical and social functioning was noted in the group receiving pharmacotherapy. However, after 5 years, compared with other baseline measurements, only physical functioning remained significantly improved. In the RF ablation group, at 1 year and 5 years of observation, improvement was noted in physical and emotional dimensions as well as in self-rated psychological health. However, in such dimensions as self-rated general health, bodily pains, social functioning, and vitality, the extent of improvement was lower after 5 years of observation. Compared with their pharmacologically treated counterparts, RF-ablation patients continued to have significantly better indicators of HRQoL even after 5 years of observation. As opposed to those treated using pharmacotherapy, patients treated using ablation reported complete elimination of symptoms (e.g., dizziness, palpitations, syncope) significantly more often (70% versus 43%). Interestingly, at baseline, women had a worse perception of arrhythmia than men. Compared with men, the HRQoL of women was lower across all dimensions of the SF-36. However, after 5 years of observation, in most of the dimensions of the SF-36, women reported greater improvement in QoL than men.