Quality of life in nonpharmacologic treatment of atrial fibrillation

The mainstay of treatment for atrial fibrillation, AF, remains pharmacologic control, either by maintaining sinus rhythm or by controlling the ventricular rate and allowing AF to continue. In patients where pharmacologic therapy i not effective, not tolerated or contraindicated, nonpharmacologic treatment may be beneficial. In the last two decades the number of nonpharmacologic treatment options (catheter ablation, cardiac pacing, internal defibrillation, and dysrhythmia surgery) for AF have markedly increased and the number of patients undergoing such treatment is steadily increasing. The most important reason for these treatment strategies is the hope of reducing symptoms, preventing complications and improving quality of life, QoL. However, the impact of nonpharmacologic therapy on QoL is far from established. Following a short presentation of the basic definitions and instruments used in QoL research the present paper reviews clinical studies that have assessed QoL in patients undergoing nonpharmacologic treatment of AF. Major limitations and methodological problems are emphasized. Among these are highly selected often-heterogeneous patients groups, small size, lack of control group and the use of non-validated QoL instruments. Furthermore, in most studies antiarrhythmic medication have been discontinued at the time of the intervention and it is not clear to which degree the improvement in QoL is related solely to the nonpharmacologic treatment or to the removal of drug related adverse effects. Although the currently available data from adequately designed studies are sparse and further investigations are needed, it is noteworthy that the majority of patients undergoing nonpharmacologic treatment report enhanced QoL.