Symptomatic and Asymptomatic Atrial Fibrillation after Pulmonary Vein Ablation and the Impact on Quality of Life

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Abstract
The aim of this prospective study was to evaluate the recurrences of atrial fibrillation (AF) and flutter (AFL) after circumferential pulmonary vein ablation (CPVA) using repetitive long-term Holter recordings, and to evaluate the change in quality of life (QoL), especially in patients with asymptomatic AF recurrences. A total of 149 patients with AF were followed up with 7-day Holter monitoring at 3, 6, and 12 months after CPVA. We calculated the burden of AF/AFL defined as the percentage of time in AF/AFL, and patients with documented arrhythmia were divided into isolated symptomatic episodes of arrhythmia, mixed symptomatic/asymptomatic arrhythmia, or isolated asymptomatic arrhythmia. The QoL was analyzed with SF-36 questionnaires in patients with sinus rhythm after CPVA, and in patients with recurrence of symptomatic and asymptomatic arrhythmia, respectively. Asymptomatic arrhythmia was observed in 44% of the patients with documented arrhythmia at 12 months of follow-up. In patients with persistent AF, 63% of the documented arrhythmia at 12 months of follow-up was asymptomatic and often persistent. In the subgroup of patients with asymptomatic arrhythmia, the QoL improved significantly in the physical scores, in contrast to patients with symptomatic arrhythmia who had unchanged or worsened QoL scores. Asymptomatic arrhythmia is very common after AF ablation. Our data indicate that these patients improve their physical component of the QoL significantly, which may be considered a palliative success of treatment. We suggest that patients with asymptomatic AF recurrences are carefully evaluated before considering reablation. Repetitive rhythm monitoring after AF ablation is very important considering the postablation management of anticoagulant therapy.

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