josé ramón gonzález juanatey cardiology and intensive cardiac care department

Quality of Life in Patients with Typical Atrial Flutter Following Cavotricuspid

Isthmus Ablation.The Santiago Cohort

José Ramón González JuanateyCardiology and Intensive Cardiac Care Department University Hospital. Santiago de Compostela. Spain

Atrial Tachycardias

Focal Macroreentry

●Automatismo

●Actividad desencadenada

●Microreentrada

● Flúter auricular derecho

Flúter auricular dependiente del istmo

cavotricuspídeo

- Típico o antihorario

- Típico reverso u horario

- Reentrada de doble onda

- Reentrada inferior (lower loop reentry)

- Reentrada intraístmica

Flúter auricular no dependiente del istmo

cavotricuspídeo

- Reentrada de la pared libre derecha

- Incisional

- Reentrada superior (upper loop reentry)

● Flúter auricular izquierdo

- Perimitral - En relación con venas pulmonares

- Septal

Saoudi et al. Eur Heart J 2001;22:1162-82

Atrial Flutter. Clasification

Reverse Typical Atrial Flutter. ECG

Flutter Wave: ♦ Componente negativo que precede al positivo en derivaciones inferiores. A veces este componente lo hace indistinguible del Fl típico.♦ Melladura en derivaciones inferiores y V1♦ V1 negativa y mellada♦ DI positiva♦ aVL negativa

Atrial Flutter Ablation

Clinical Objectives

Increase functionalcapacity

Symptoms improvemen

t

Increase Quality of Life

Improve Survival

Improve Atrial dysfunction

Electrical stability

Reduce Morbidity

BP=blood pressure; COPD=chronic obstructive pulmonary disease

Francisco Javier García SearaEvaluación de la calidad de vida y remodelado cardíaco en pacientes sometidos a ablación de Flúter auricular dependiente del istmo cavo-tricuspídeo

Quality of Life and Atrial Flutter ablation

Different studies have proved an improvement in QoL after CTI AFl ablation 1-5 but

most of them:

Not standardized nor normalized (american population).

Standardized and normalized to american but not to own population.

Not adjusted by age and sex (the oldest have poor QoL and male have better

QoL than female).

Subgroups has not been analized (especially atrial fibrillation).

Results has never been expressed as important clinical minimal differences

(MID). This concept allows to know if a treatment produces a relevant clinical

benefit to the patient and not only statistically significant changes.

Not evaluation in a short and long-term.

Not Evaluation of structural and functional cardiac changes.

1. Calkins et al. Am J Cardiol 2004; 94:437-42; 2. O´Callaghan et al Heart 2001;86:167-71; 3. Feld et al. Am Coll Cardiol

2004;43:1466-72; 4. Lee et al. Am J Cardiol 1999;84:278-83. 5. Meissner et al. Clin Res Cardiol 2007;96:1-9.


Garcia Seara et al. Rev Esp Cardiol 2011;64:401-408

Atrial Flutter Santiago Cohort. Clinical Characteristics

Age (years) 64,4 ± 10,6

Gend Men, n (%) 77 (81,1)

Women, n (%) 18 (18,9)

COPD, n (%) 20 (21,1)

HT, n (%) 47 (49,5)

Smoking, n (%) 45 (47,4)

Hiperlipidemia, n (%) 41 (43,2)

Excessive alcohol consumption, n (%) 12 (12,6)

Obesity, n (%) 25 (26,3)

Hypertensive heart disease, n (%) 37 (38,9)

Valve disease, n (%) 19 (20,0)

Type of valve disease, n (%)

Aortic stenosis 4 (4,2)

Mitral regurgitation 12 (12,6)

Tricuspid regurgitation 3 (3,2)

Ischemic heart disease, n (%) 14 (14,7)

Previous myocardial infarction, n (%) 10 (10,5)

Heart failure, n (%) 18 (18,9)

Dilated cardiomyopathy, n (%) 21 (22,1)

Following heart surgery, n (%) 12 (12,6)

Type of surgery, n (%)

Aortocoronary bypass 8 (8,3)

Pericardiectomy 1 (1,1)

Valvular 3 (3,2)

No Heart Disease, n (%) 20 (21,1)

LVEF<50%, n (%) 22 (23,1)

Cor Pulmonale, n (%) 5 (5,3)

Bronchial asthma, n (%) 5 (5,3)

Presenting form of flutter, n (%) -Paroxysmal -Persistent

53 (55,8)42 (44,2)

Type of Flutter, n (%) -Typical (Anticlockwise) -Inverse Typical (Clockwise) -Both

82 (86,3)6 (6,3)7 (7,4)

Previous atrial fibrillation, n (%) 41 (43,2)

Atrial Flutter Santiago Cohort. Clinical Characteristics

Short Form (SF-36) Quality of Life Questionnaire

ScalesNº

itemsSummary

Physical functioning

Role physical

Bodily pain

General Health

Vitality

Social Functioning

Role emotional

Mental Health

Health status transition

10

4

2

5

4

2

3

5

1

● Limitation in performing all physical activities, including bathing or dressing.

● Problems with work or other daily activities as a result of physical health

● Limitations due to pain

● Evaluation of personal health

● Feeling of energy an vitality

● Interference with normal social activities due to physicial and emotional problems

● Problems with work or other daily activities as a result of emotional problems

● Feelings of nervousness and depression

● Evaluation of general health and compared with 1 year ago


Flutter Ablation. Procedure Complications and Follow-upAtrial Fib follow-up, n (%) 24 (25,3)

Complications, n (%) -Hematoma -Pericardial effusion -Vagal -Ischemic Stroke -Bleeding complications, n / anticoagulated patients, n; (%)

2 (2,1)1 (1,1)1 (1,1)3 (3,2)3 / 61 ; (4,9)

Pain, n (%) -No stop procedure -Stop + Analgesia no opiácea -Stop + Analgesia opiácea

41 (43,2)5 (12,2)13 (31,7)23 (56,1)

Cardiac procedures during the follow-up, n (%) -CTI Re-ablation -AV node Ablation -Permanent Pacemaker during follow-up -CVE / CVP A Fib -CVE / CVP A Fl

30 (31,6)12 (40) – 14%3 (10)5 (16,7)3 (10) / 3 (10)3 (10) / 1 (3,3)

1-year Rthym, n (%) -SR -A Fib -A Fl

81 (91,0)7 (7,9)1 (1,1)

OAC follow-up, n (%) 48 (53,9)

Antiplatelet Tx follow-up, n (%) 24 (27,0)

1-year Mortality, n (%) 6 (6,3)


Baseline Quality of Life. Standarized and Normalized for the Spanish Population. Age and gender-adjusted

N= 95 Mean Median SD

Physical function 43,9 46,8 11,7

Role physical 38,3 35,8 11,4

Bodily pain 47,8 49,0 10,8

General Health 42,9 42,3 9,4

Vitality 41,7 40,7 10,7

Social Function 43,5 47,8 15,0

Role Emotional 40,3 46,4 15,7

Mental Health 41,9 44,4 11,3

CSF 44,3 44,4 10,1

CSM 41,2 45,8 14,5

CSF: component summary PhysicalCSM: component summary MentalSD: Estándar deviation

FF RF DC SG VT AS RE SM CSF CSM

-20

0

20

40

60

80

FF: función físicaRF: rol físicoDC: dolor corporalSG: salud general

VT: vitalidadAS: actividad socialRE: rol emocionalSM: salud mentalPopulation Mean and SD: 50 ± 10

Light Deviations: > 4 puntosModerate Deviations: > 6 puntosSevere Deviations: > 8 puntos

Garcia Seara et al. Cuad. Estimulación cardíaca 2010:31-41


N= 88 Pts Media Mediana DE

Physical function 54,5 55,7 6,6

Role physical 49,9 55,3 8,8

Bodily pain 51,2 57,0 9,6

General Health 49,5 49,4 10,0

Vitality 52,3 53,8 9,7

Social Function 50,6 55,2 11,0

Role Emotional 49,5 53,8 12,1

Mental Health 50,1 52,2 8,9

CSF 52,2 53,7 8,2

CSM 49,4 53,1 11,4

CSF: component summary PhysicalCSM: component summary MentalFF: función físicaRF: rol físicoDC: dolor corporal


0

10

20

30

40

50

60

70

SG:salud generalVT: vitalidadAS: actividad socialRE: rol emocionalSM: salud mental

Garcia Seara et al. Cuad. Estimulación cardíaca 2010:31-41

1-year Quality of Life. Standarized and Normalized for the Spanish Population. Age and gender-adjusted


Quality of Life at Baseline and 1-Year Follow-up, Standarized and Normalized for the Spanish Population.

Adjusted for Age and Gender

Garcia SearaJ, …, González-Juanatey JR et al. Rev Esp Cardiol 2011;64:401-408



-40

-20

0

20

40

60

N=88 Mean Median SD p

Physical function

10,4 8,5 10,1 0,000*

Role physical

11,8 11,1 12,1 0,000*

Bodily pain 3,4 0,0 11,2 0,06

General Health

6,9 5,5 8,6 0,000*

Vitality 10,7 11,0 10,6 0,000*

Social Function

9,9 0,0 13,1 0,000*

Role Emotional

7,6 5,1 11,6 0,000*

Mental Health

8,5 7,9 11,1 0,000*

CSF 7,8 7,0 9,7 0,000*

CSM 8,9 6,0 12,7 0,000*

*p<0,05;CSF: component summary Physical ;CSM: component summary Mental; SD: standard deviation


VT: vitalidadAS: actividad socialRE: rol emocionalSM: salud mental

Garcia Seara et al. Rev Esp Cardiol.2011

Absolute Differences in Quality of Life at Baseline and 1-Year Follow-up,

Standarized and Normalized for the Spanish Population. Adjusted for Age and Gender

Population Mean and SD: 50 ± 10Light Deviations: > 4 puntosModerate Deviations: > 6 puntosSevere Deviations: > 8 puntos


N=88 Mean ES SRM MCID (ES) MCID (SRM)

Physical function 10,4 ± 10,1 0,88 1,03 0,62 0,69

Role physical 11,8 ± 12,1 1,00 0,94 0,75 0,68

Bodily pain 3,4 ± 11,2 0,31 0,30 0,62 0,62

General Health 6,9 ± 8,6 0,74 0,80 0,56 0,54

Vitality 10,7 ± 10,6 0,99 1,01 0,59 0,59

Social Function 9,9 ± 13,1 0,63 0,76 0,64 0,70

Role Emotional 7,6 ± 11,6 0,50 0,66 0,58 0,66

Mental Health 8,5 ± 11,1 0,74 0,77 0,65 0,66

CSF 7,8 ± 9,7 0,78 0,80 0,62 0,58

CSM 8,9 ± 12,7 0,60 0,70 0,55 0,64

ES: Effect sizeSRM: Standarized Response MeanMCID: Minimum clinically important differenceCSF: Component summary Physical; CSM: Component summary Mental

● ≥0,80: Important Variations

●0,50-0,79: Moderate Variations

●0,20-0,49: Light Variations

●0,01-0,19: Very modest Variations

Garcia Seara et al. Rev Esp Cardiol.2011;64;401-08

Differences in Quality of Life at Baseline and 1-Year Follow-up Standarized and Normalized for the Spanish Population. Adjusted for Age and Gender


FA post

-100

-50

0

50

100 FF

RF

DC

SG

VT

RE

AS

SM

Sí No

Atrial Fibrillation during the Follow-up

A Fib (N=23)

No A Fib (N= 65)

p

Physical function 24,1 ± 23,9 24,5 ± 20,1

0,94

Role physical 34,3 ± 39,6 48,8 ± 47,3 0,19

Bodily pain 10,4 ± 31,6 [0]

9,6 ± 32,2 [0]

0,91

General Health 10,2 ± 19,4 17,1 ± 19,2 0,15

Vitality 20,4 ± 26,5 26,6 ± 23,1 0,32

Social Function 16,0 ± 19,1 16,7 ± 27,1 [0]

0,88

Role Emotional 34,8 ± 43,2 [0]

30,3 ± 39,8 [0]

0,66

Mental Health 13,2 ± 21,8 19,4 ± 23,5 0,25*p<0,05; Los datos se expresan en mean ± SDSD: standard deviation



Garcia Seara et al. Health Qual Life Outcomes 2012

Differences in Quality of Life at Baseline and 1-Year Follow-up


Fibrilación auricular post

-25

0

25

50

75

100

125 FF

RF

DC

SG

VT

AS

RE

SM

CSF

CSM

Sí No

A Fib (N=23) No A Fib (N= 65)

p

Physical function

83,0 ± 14,2 86,1 ± 15,8 0,40

Role physical

60,4 ± 39,2 82,3 ± 30,8 0,008*

Bodily pain 69,7 ± 30,0 81,8 ± 27,4 0,07

General Health

46,1 ± 21,3 62,8 ± 18,9 0,001*

Vitality 58,9 ± 21,1 71,0 ± 23,2 0,03*

Social Function

83,1 ± 26,3 91,7 ± 18,4 0,09

Role Emotional

76,8 ± 41,9 92,8 ± 21,6 0,02*

Mental Health

64,9 ± 18,7 76,7 ± 17,4 0,007*

CSF 62,9 ± 22,9 75,0 ± 26,9 0,05*

CSM 67,3 ± 32,8 79,7 ± 20,9 0,04*

FF: función física RF: rol físicoDC: dolor corporalSG: salud general


Atrial Fibrillation during Follow-up


Quality of Life Dimensions at 1-Year

*p<0,05; Data are expressed as mean ± SDCSF: component summary PhysicalCSM: component summary MentalSD: standard deviation


Paroxistico Persistente

Tipo Flutter

-100

-50

0

50

100 FF

RF

DC

SG

VT

RE

AS

SM

Type of Atrial Flutter

Paroxysmal (N=51)

Persistent (N= 37)

p

Physical function

24,9 ± 21,7 23,8 ± 20,3 0,80

Role physical 44,4 ± 46,4 45,9 ± 45,1 0,88

Bodily pain 10,7 ± 34,0 8,6 ± 29,1 0,75

General Health 14,6 ± 16,7 16,3 ± 22,7 0,69

Vitality 21,4 ± 21,9 30,0 ± 26,2 0,09

Social Function 14,0 ± 23,4 20,1 ± 27,3 0,26

Role Emotional 30,1 ± 41,2 33,3 ± 40,1 0,71

Mental Health 15,0 ± 3,1 21,6 ± 22,9 0,19

*p<0,05; Data are expressed as mean ± DDE: Standard deviation





Paroxysmal (N=51)

Persistent (N= 37)

p

Physical function

83,5 ± 14,9 87,8 ± 15,9 0,19

Role physical

74,3 ± 35,3 [100]

79,7 ± 33,2 [100]

0,46

Bodily pain 77,1 ± 29,0 [100]

80,8 ± 27,9 [100]

0,54

General Health

54,6 ± 21,4 63,8 ± 18,9 0,036*

Vitality 62,7 ± 22,1 74,9 ± 23,2 0,016*

Social Function

88,0 ± 31,3 [100]

91,5 ± 20,6 [100]

0,43

Role Emotional

86,9 ± 31,3 [100]

91,0 ± 25,6 [100]

0,50

Mental Health

71,1 ± 20,0 77,1 ± 15,6 0,12

*p<0,05; Data are expressed as mean ± SD and [median].

Paroxistico Persistente

Tipo Flutter

0

20

40

60

80

100 FF

RF

DC

SG

VT

AS

RE

SM

Type of of Atrial Flutter


VT: vitalidadAS: actividad socialRE: rol emocionalSM: salud mental.

Quality of Life Dimensions at 1-Year


Sexo

-100

-50

0

50

100 FF

RF

DC

SG

VT

RE

AS

SM

Varón Mujer

Gender

Men (N=72)

Women (N= 16)

p

Physical function

25,1 ± 21,3 21,2 ± 20,2 0,50

Role physical 43,6 ± 46,3 51,6 ± 43,3 0,53

Bodily pain 9,8 ± 34,0 9,9 ± 21,0 0,99

General Health 15,7 ± 19,6 13,6 ± 18,5 0,70

Vitality 26,7 ± 24,9 17,5 ± 18,9 0,17

Social Function 14,0 ± 23,4 20,1 ± 27,3 0,21

Role Emotional 25,9 ± 38,4 56,2 ± 41,7 0,006*

Mental Health 18,3 ± 22,4 15,5 ± 26,5 0,66

*p<0,05; Los datos se expresan en media ± DESD: standard deviation





Structural Cardiac Disease

Yes (N=68) No (N= 20) p

Physical function

26,5 ± 20,8 17,5 ± 20,9 0,10

Role physical 49,8 ± 46,9 28,7 ± 37,4 0,04*

Bodily pain 8,6 ± 30,5 14,0 ± 36,5 0,55

General Health

16,1 ± 20,3 12,6 ± 15,9 0,42

Vitality 27,4 ± 23,8 16,7 ± 23,7 0,08

Social Function

14,8 ± 25,6 22,1 ± 23,3 0,24

Role Emotional

29,9 ± 39,5 36,7 ± 44,5 0,54

Mental Health 18,5 ± 23,7 15,4 ± 21,4 0,57 Cardiopatia

-100

-50

0

50

100 FF

RF

DC

SG

VT

RE

AS

SM

No Sí






Number of Episodes

1 episode (N=37)

>1episodes (N= 51)

p

Physical function

18,4 ± 17,5 28,8 ± 22,4 0,02*

Role physical 40,5 ± 40,1 48,3 ± 49,4 0,41

Bodily pain 9,1 ± 30,5 10,3 ± 33,1 0,85

General Health

13,2 ± 22,8 16,9 ± 16,5 0,40

Vitality 24,3 ± 21,7 25,5 ± 25,8 0,81

Social Function

18,4 ± 26,1 15,2 ± 24,5 0,56

Role Emotional

30,6 ± 38,0 32,0 ± 42,7 0,87

Mental Health 16,5 ± 23,0 18,7 ± 23,3 0,66 Nºepisodios

-100

-50

0

50

100 FF

RF

DC

SG

VT

RE

AS

SM

1 ≥ 2






≤500 ms (N=8)

>500 ms (N=28)

p

Physical function

32,5 ± 30,9 21,2 ± 16,5 0,17

Role physical 71,9 ± 36,4 36,6 ± 44,3 0,04*

Bodily pain 20,5 ± 36,2 5,5 ± 27,1 0,20

General Health 34,3 ± 15,0 11,0 ± 22,4 0,009*

Vitality 45,6 ± 27,3 24,3 ± 23,9 0,04*

Social Function

26,6 ± 33,7 18,9 ± 25,8 0,40

Role Emotional

50,0 ± 39,8

29,8 ± 39,9 0,21

Mental Health 35,5 ± 21,4 16,6 ± 21,5 0,03* Ciclo ventricular

-50

-25

0

25

50

75

100 FF

RF

DC

SG

VT

FE

AS

SM

≤ 500 ms > 500 ms

Persistent Flutter and Ventricular Cycle







Flutter Type / Ventricular Cycle / Structural Heart Disease

A Fl pers., <500 ms and structural CD (N=7)

A Fl parox., >500 ms, No structural CD (N=3)

p

Physical function

37,8 ± 29,1 28,3 ± 30,5 0,83

Role physical 75,0 ± 38,1 16,6 ± 14,4 0,07

Bodily pain 16,6 ± 37,2 26,0 ± 37,5 0,52

General Health 37,0 ± 13,8 23,3 ± 20,8 0,27

Vitality 46,4 ± 29,4 20,0 ± 27,8 0,18

Social Function 26,8 ± 36,4 12,5 ± 37,5 0,83

Role Emotional 50,0 ± 39,8 33,3 ± 57,7 0,67

Mental Health 36,0 ± 23,1 1,3 ± 23,1 0,18

CSF 41,2 ± 23,8 25,8 ± 15,6 0,27

CSM 35,6 ± 35,7 11,4 ± 42,7 0,27

TES 2,85 ± 1,06 0,33 ± 1,15 0,03*

*p<0,05. Los datos se expresan en media ± DE. FF: función física; RF: rol físico; DC: dolor corporal; SG: salud general; VT: vitalidad; AS: actividad social; RE: rol emocional; SM: salud mental, CSF: componente sumario físico, CSM: componente sumario mental; TES: transición del estado de salud; FlA pers.: flúter persistente, FlA parox.: flúter paroxístico; Cp: cardiopatía




Structural and Functional Cardiac Remodeling. Differences among cardiac structural and funcional parameters

Differences Follow-up-baseline (N= 50)

Mean ± SD p

RA Area diastole, cm2 -4,2 ± 6,2 0,000*

RA Area AD systole, cm2 -4,1 ± 4,7 0,000*

cfRA +0,17 ± 0,16 0,000*

LA Area, cm2 -0,99 ± 0,9 0,35

dLA , cm -0,08 ± 0,6 0,36

LVEF, % +8,8 ± 14,8 0,001*

HR, lpm -3,5 ± 13,1 0,07

LVEDD, cm -0,24 ± 0,5 0,01*

LVESD, cm -0,43 ± 0,7 0.001*

IVST, cm -0,09 ± 0,2 0,02*

PWT, cm -0,05 ± 0,2 0,17

E, m/s -0,09 ± 0,2 0,01*

A, m/s +0,30 ± 0,0,3 0,000*

E/A -1,3 ± 2,0 0,000*

Decelerac E, ms +37 ± 56 0,000*

IVRT, ms -3 ± 29 0,55

*p<0,05Cuantitative data are expressed as mean ± SD● AD: Aurícula derecha● cf: fracción de acortamiento● AI: aurícula izquierda● dAI: dimensión de aurícula izquierda● FEVI: fracción de eyección de ventrículo izquierdo● VD: ventrículo derecho● FC: frecuencia cardíaca● E: velocidad máxima de onda E● A: velocidad máxima de onda A● E/A:cociente entre E y A● TdecE: tiempo de deceleración de la onda E● TRIV:tiempo de relajaciónisovolumétrica● TIV: tabique interventricular● DTD:diámetro telediastólico de VI● DTS:diámetro telesistólico de VI● PP: pared posterior de VI

Garcia Seara et al. Rev Esp Cardiol 2012


Diastolic Left Ventricular Function

P=0,22 P=0,000

Garcia Seara et al. Rev Esp Cardiol 2012

Structural and Functional Cardiac Remodeling. Differences among cardiac structural and funcional parameters

Dimension Baseline 1 year 6 years P* P**Physical function

61,6 (24,0)44,3 (11,9)

85,1 (15,8) 54,3 (6,7)

61,7 (24,7) 44,4 (10,1)

<0,001<0,001

0,6210,870

Role physical 34,1 (42,1)38,6 (11,7)

74,7 (35,9) 49,4 (9,1)

63,5 (41,6) 46,4 (10,9)

<0,001<0,001

<0,001<0,001

Bodily pain 70,4 (31,4)48,3 (10,7)

78,4 (28,6) 51,0 (9,7)

60,9 (28,0) 44,8 (9,7)

<0,001<0,001

0,0030,003

General Health 43,5 (19,0)42,8 (9,4)

57,8 (21,4) 48,2 (10,2)

46,1 (19,7) 43,6 (9,9)

<0,001<0,001

0,2260,226

Vitality 43,7 (24,6)41,9 (10,9)

67,9 (23,0) 52,3 (9,7)

50,0 (27,6) 44,4 (12,0)

<0,001<0,001

0,0600,038

Social Function 74,2 (29,0)43,5 (15,2)

90,1 (20,5) 50,9 (10,6)

75,5 (27,6) 44,2 (13,4)

<0,001<0,001

0,9150,717

Role Emotional 60,1 (44,2)40,4 (15,9)

88,1 (29,2) 49,3 (12,1)

68,0 (44,6) 43,0 (16,0)

<0,001<0,001

0,1740,142

Mental Health 56,9 (23,0)42,0 (11,3)

73,0 (18,8) 49,7 (12,9)

65,7 (23,9) 46,1 (11,4)

<0,001<0,001

0,0010,001

CSF 49,2 (28,4)44,6 (10,3)

71,1 (26,7) 52,0 (8,3)

53,7 (29,1) 45,1 (10,1)

<0,001<0,001

0,7110,596

CSM 57,9 (34,2)41,2 (14,8)

76,5 (24,5) 49,4 (11,2)

64,7 (35,0) 44,5 (15,0)

<0,001<0,001

0,0700.057

p*: baseline- 1 yp**: baseline- 6 y

Quality of Life at Long-term after CTI Ablation


Cabanas-Grandío et al. Health Qual Life Outcomes 2014



Dimension Mean DE TE SRM MID (TE) MID (SRM)

Physical function 0,2 10,4 0,08 0,02 0,50 0,58Role physical 8,5 13,4 0,67 0,63 0,65 0,59Bodily pain -3,7 10,1 0,32 0,37 0,60 0,63General Health 1,3 8,8 0,08 0,15 0,51 0,54Vitality 2,3 10,3 0,23 0,22 0,51 0,53Social Function 0,5 12,3 0,05 0,04 0,47 0,58Role Emotional 2,8 16,3 0,03 0,17 0,58 0,57Mental Health 4,2 10,8 0,35 0,39 0,54 0,56

PCS 0,7 11,0 0,05 0,06 0,63 0,60

MCS 3,3 14,8 0,22 0,22 0,56 0.57

Cabanas-Grandío et al. Health Qual Life Outcomes 2014



Dimension

6-y Follow-up 1-y Follow-up

P* P**A Fib

(n= 38)

No A Fib

(n= 36)

A Fib

(n= 23)

No A Fib

(n= 64)Physical function

59,7 (25,0) 63,8 (24,7) 83,0 (14,2) 85,8 (16,4) 0,490 0,480

Role physical 55,9 (41,7) 71,5 (40,6) 59,8 (40,0) 80,1 (33,1) 0,107 0,019

Bodily pain 60,2 (27,0) 61,5 (29,4) 70,2 (30,0) 81,4 (27,8) 0,848 0,108

General Health

43,1 (17,4) 49,3 (21,5) 44,8 (20,7) 62,5 (19,7) 0,171 <0,001

Vitality 45,9 (26,2) 54,3 (28,7) 58,9 (21,2) 71,2 (22,3) 0,193 0,027

Social Function

60,4 (29,9) 81,9 (24,0) 84,2 (25,3) 92,2 (18,2) 0,051 0,110

Role Emotional

61,4 (46,2) 75,0 (42,4) 76,8 (42,0) 92,2 (22,0) 0,192 0,029

Mental Health 63,1 (23,5) 68,4 (24,3) 64,9 (18,4) 75,9 (18,3) 0,336 0,015

PCS51,0 (29,4) 56,6 (29,0) 48,1 (6,9) 53,4 (8,4) 0,409 0,008

MCS59,4 (37,8) 70,2 (31,4) 44,4 (16,0) 51,1 (8,3) 0,137 0,012

Quality of Life at Long-term after CTI Ablation. Atrial Fib


DimensionOAC

(n= 44)

No OAC

(n= 30)p

Physical function 55,5 (22,9) 70,8 (24,8) 0,008

Role physical 52,3 (42,0) 80,0 (35,6) 0,004

Bodily pain 58,4 (28,1) 64,4 (28,0) 0,367

General Health 42,6 (15,8) 51,2 (23,5) 0,064

Vitality 44,9 (24,2) 57,5 (30,8) 0,053

Social Function 72,7 (28,9) 79,6 (25,7) 0,299

Role Emotional 62,1 (45,2) 76,7 (43,0) 0,170

Mental Health 62,8 (24,0) 69,9 (23,6) 0,215

PCS 44,5 (9,0) 45,9 (11,7) 0,017

MCS 44,1 (13,8) 45,3 (16,9) 0,351


Chronic Oral Anticoagulation


Dimension

DM

No DM

BASALINE

(N=15)1 Y (N=15) 6 Y (N=15)

BASALINE

(N=59)1 Y (N=59) 6 Y (N=59)

Función Física†52,0 (24,5) 80,0 (16,6) 51,4 (23,2) 65,1 (23,1) 87,6 (14,3) 64,1 (24,7)

Rol Físico*†31,7 (43,8) 61,7 (39,9) 42,9 (48,5) 31,7 (41,4) 80,5 (32,2) 68,3 (38,7)

Dolor Corporal58,3 (34,9) 66,3 (31,1) 53,2 (28,4) 74,0 (30,0) 81,2 (28,3) 62,6 (27,9)

Salud General†36,5 (14,2) 46,8 (15,3) 36,7 (8,6) 44,5 (19,4) 60,2 (22,2) 48,3 (20,9)

Vitalidad*† 41,3 (25,7) 58,0 (24,6) 38,9 (24,4) 44,9 (24,7) 71,7 (20,9) 52,6 (27,8)

Función Social*†§74,2 (21,9) 89,2 (17,6) 59,8 (26,5) 75,4 (29,4) 91,3 (19,4) 79,2 (26,9)

Rol emocional*†§71,1 (43,4) 93,3 (25,8) 50,0 (51,9) 56,7 (45,2) 84,7 (32,4) 72,2 (42,1)

Salud Mental*† 56,6 (26,0) 67,5 (19,6) 46,6 (26,4) 56,6 (24,0) 73,6 (19,3) 67,8 (23,0)

PCS† 40,4 (9,0) 47,5 (7,7) 41,5 (11,4) 45,2 (10,6) 53,5 (7,3) 45,9 (9,7)

MCS*§ 44,6 (13,4) 50,1 (8,3) 40,2 (15,2) 40,2 (16,1) 48,5 (12,8) 45,6 (14,9)

Quality of Life at Long-term after CTI Ablation. Diabetes


Factors Related to Long-term Quality of Life after CTI Ablation

Physical Component Summary Mental Component Summary

Cabanas-Grandio P et al. Health and QofL Outcomes. 2014; 12: 47


Atrial Fibrillation-free Survival. Atrial Fl Ablation Santiago Cohort

Seara JG et al. Clin Res in Cardiol. 2014


Atrial Fib Incidence after CTI Ablation. The Santiago Cohort


Atrial Fib, Stroke and Death Risk after Atrial Flutter Ablation


Atrial Fibrillation, Stroke and Death Determinants in Patients with CTI Ablation. Multivariate Analysis


Stroke and Death Determinants in Patients with Atrial Fibrillation during Follow-up. Multivariate Analysis


Atrial Fib Recurrence after CTI Ablation. The Santiago Cohort

Group 3: isolated AFLGroup 2: Afib + AFL Group 1: IC AFL

García Seara et al. Int J Cardiol. June 2014


Conclusions

A clinically significative improvement in HRQoL measures after 1-year was found in patients with typical trial flutter who underwent cavotricuspid isthmus catheter ablation and can be offered as a valid therapeutic alternativa to most of the patients

In our population we found inverse structural and functional cardiac remodelling at 1-year follow-up with much improved left ventricular ejection fraction, right atrium contraction fraction, and diastolic dysfunction pattern.

CTI ablation provides a sugnificant improvement in long-term QoL for the dimensions of Physical Role, Vitality and Mental Health. Previous diabetes mellitus, Atrial Fib, oral anticoagulation, basal QoL and Atrial Flutter recurrence were determinants of a worse long-term QoL.

Patients with Atrial Fib during follow-up show a significant lowe HRQoL at 1-year post-ablation.

josé ramón gonzález juanatey cardiology and intensive cardiac care department

Documents

typical atrial flutter

atrial fibrillation

j cardiol

en relacin

esp cardiol

coll cardiol

eur heart j

clin res cardiol