Sustained Improvement in Quality of Life Following Catheter Ablation for Persistent AF Beyond 3 Years: That's No Sham

Catheter ablation (CA) is an effective treatment for atrial fibrillation (AF) that improves arrhythmia burden and quality of life (QOL). However, there are limited data on long-term QOL outcomes in patients with persistent AF (PsAF).

This study sought to evaluate long-term QOL outcomes up to 3 years post-ablation for patients with PsAF in CAPLA (Catheter Ablation for Persistent Atrial Fibrillation: A Multicentre Randomized Trial of Pulmonary Vein Isolation vs PVI With Posterior Left Atrial Wall Isolation).

CAPLA was a large, multicenter, international trial that randomized patients with PsAF to an ablation strategy of either pulmonary vein isolation alone or in combination with posterior wall isolation. In this secondary analysis, QOL was assessed using the Atrial Fibrillation Effect on QualiTy-of-life (AFEQT) questionnaire, evaluated before ablation and repeated at 6 months, 1 year, and 3 years post-ablation. Patients underwent intensive rhythm monitoring to calculate 3-year AF burden. Statistical significance was set at P <0.05.

Of 338 patients randomized in CAPLA, 309 (91.4%) had complete QOL data at 3 years post-ablation. The mean AFEQT score rose from 53.7 ± 22.6 at baseline to 78.7 ± 20.1 at 12 months and further increased to 88.4 ± 14.8 at 3 years (P < 0.001). Significant improvements were noted across all AFEQT subdomains, including symptoms, activity limitations, and treatment concerns. A significant negative correlation was observed between AF burden and QOL at 3 years (r = -0.45; P < 0.001), with AF burden >5% associated with no significant improvement in QOL.

CA for PsAF resulted in a significant incremental improvement in QOL over long-term follow-up. The sustained nature of QOL improvement over 3 years following ablation argues against a placebo effect.