Skip to main content
SpringerLink
Log in

Pharmacological and ablative hybrid therapy of atrial fibrillation

Long-term effect on quality of life and arrhythmia-related symptoms

Pharmakologische und ablative Hybridtherapie von Vorhofflimmern—Einfluss auf Lebensqualität und Arrhythmie-korrlierte Symptome im Langzeitverlauf

  • ORIGINAL PAPER
  • Published:
Zeitschrift für Kardiologie Aims and scope Submit manuscript

Zusammenfassung

Die pharmakologische und ablative Hybrid- Therapie von Vorhofflimmern (VF) beinhaltet die Radiofrequenzablation von Antiarrhythmika-induziertem Vorhofflattern (VFl) und mit nachfolgender Fortsetzung der antiarrhythmischen Medikation. Ziel dieser Arbeit war es, die Langzeiteffektivität dieser Therapie auf VF-Symptomen und Lebensqualität zu evaluieren. Bei 46 Patienten mit symptomatischem VF konnte eine Isthmus-Ablation von Antiarrhythmika-induziertem Vorhofflattern durchgeführt werden. Mittels SF-36- und Symptoms Checklist-Frequency and Severity Scale-Fragebogen und der Auswertung von EKGs wurde die VF-Charakteristik, die VF-bezogenen Symptomen und die Lebensqualität vor und nach Ablation retrospektiv evaluiert. 63% der Patienten zeigten während der Nachbeobachtungszeit von 22,4±11,6 Monaten ein VF-Rezidiv. Eine signifikante Reduktion der Anzahl sowie der Dauer der Episoden konnte in 82,6 bzw. 76% der Patienten beobachtet werden. Jede Kategorie des SF-36 zeigte eine signifikante Verbesserung, die VF-bezogenen Symptome verminderten sich signifikant bei 65,8% der Patienten.

Schlussfolgerung

Mittels einer pharmakologischen und ablativen Hybrid-Therapie konnte eine signifikante Reduktion der Anzahl und Dauer der symptomatischen VF-Episoden, der VF-bezogenen Beschwerden und eine signifikante Verbesserung der Lebensqualität erzielt werden.

Summary

The pharmacological and ablative hybrid therapy of atrial fibrillation (AF) consists of radiofrequency catheter ablation of antiarrhythmic drug-induced typical atrial flutter (AFl) and continuation of drug therapy. The purpose of this study was to determine the effect of this therapy on AF symptoms and quality of life (QoL). Forty-six patients were monitored after isthmus-ablation of drug-induced typical AFl and continuation of their antiarrhythmic drug treatment over a mean follow-up of 22.4±11.6 months. AF characteristics, symptoms and QoL before and after ablation were evaluated by the SF-36 question- naire, the Symptoms Checklist-Frequency and Severity Scale and the analysis of ECG recordings. 63% of patients demonstrated recurrences of AF. However, the frequency and duration of symptomatic episodes significantly decreased in 82.6 and 76% of patients. All categories of the SF-36 improved significantly and the AF symptomatology showed a relevant attenuation in 65.8% of the study population.

Conclusion

The pharmacological and ablative hybrid therapy significantly reduced the mean number and the duration of symptomatic AF episodes as well as AF-correlated symptoms and was associated with significant QoL improvement.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

References

  1. Anselme F, Saoudi N, Poty H, Douillet R, Cribier A (1999) Radiofrequency catheter ablation of common atrial flutter significance of palpitation and quality-of-life evaluation in patients with proven Isthmus block. Circulation 99:543–540

    Google Scholar 

  2. Bubien RS, Knotts-Dolson SM, Plumb VJ, Kay GN (1996) Effect of Radiofrequency catheter ablation on healthrelated quality of life and activities of daily living in patients with recurrent arrhythmias. Circulation 94:1585–1591

    PubMed  Google Scholar 

  3. Cheng TO (1956) Atrial flutter during quinidine therapy of atrial fibrillation. Am Heart J 52:273–289

    Article  PubMed  Google Scholar 

  4. Cosio FG, Lopez M, Gociolea A, Arribas F, Barroso JL (1993) Radiofrequency ablation of the inferior vena cava-tricuspid valve isthmus in common atrial flutter. Am J Cardiol 71:705–709

    Article  PubMed  Google Scholar 

  5. Dorian P, Jung W, Newman M, Wood K, Ayers GM, Camm J, Akhtar M, Lüderitz B (2000) The impairment of health-related quality of life in patient with intermittent atrial fibrillation. Implications for the assessment of investigational therapy. J Am Coll Cardiol 36:1303–1309

    Article  PubMed  Google Scholar 

  6. Ehrlich JR, Hohnloser SH (2005) Pharmacological cardioversion of atrial fibrillation Z Kardiol 94:14–22

    Article  PubMed  Google Scholar 

  7. Hlatky MA, Vaughn WK (1996) Quality of life in patients with supraventricular arrhythmia. Circulation 94:1491–1493

    PubMed  Google Scholar 

  8. Huang DT, Monahan KM, Zimetbaum P, Papageorgion P, Epstein LM, Josephson ME (1998) Hybrid pharmacologic and ablative therapy: a novel and effective approach for the management of atrial fibrillation. J Cardiovasc Electrophysiol 9:462–469

    PubMed  Google Scholar 

  9. Jung W, Herwig S, Camm AJ, Dorian P, Newman D, Akhtar M, Wood K, Ayers GM, Lüderitz B (1998) Impact of atrial fibrillation on quality of life: a prospective, multicenter study (Abstr). Pacing Clin Electrophysiol 21 (Par II): 981

    Google Scholar 

  10. Mc Horney CA, Ware JE, Raczek AE (1993) The MOS 36-Item Short-Form Heath Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Med Car 31:247–263

    PubMed  Google Scholar 

  11. Nabar A, Rodriguez LM, Timmermans C, Mechelen R, Wellens HJ (2001) Class IC antiarrhythmic drug induced atrial flutter: electrocardiographic and electrophysiological findings and their importance for longterm outcome after right atrial isthmus ablation. Heart 85:424–429

    Article  PubMed  Google Scholar 

  12. Nabar A, Rodriguez LM, Timmermans C, Smeets JL, Wellens HJ (1999) Radiofrequency ablation of “class IC atrial flutter” in patients with resistant atrial fibrillation. Am J Cardiol 83:785–787

    Article  PubMed  Google Scholar 

  13. Reithmann C, Hoffmann E, Spitzberger G, Dorwarth U, Gerth A, Remp T, Steinbeck G (2000) Catheter ablation of atrial flutter due to amiodarone therapy for paroxysmal atrial fibrillation. Eur Heart J 21:565–572

    Article  PubMed  Google Scholar 

  14. Riva S, Tondo C, Carbucicchio C, Galimberti P, Fassini G, Della Bella P (1999) Incidence and clinical significance of transformation of atrial fibrillation to atrial flutter in patients undergoing long-term antiarrhythmic drug treatment. Europace 1:242–247

    Article  PubMed  Google Scholar 

  15. Roithinger F, Karch MR, Steiner PR, SippensGroenewegen A, Lesh MD (1997) Relationship between atrial fibrillation and typical atrial flutter in humans: activation sequence during spontaneous conversion. Circulation 18:3484–3491

    Google Scholar 

  16. Savelieva I, Paquette M, Dorian P, Lüderitz B, Camm J (2001) Quality of life in patients with silent atrial fibrillation. Heart 85:216–217

    Article  PubMed  Google Scholar 

  17. Schrickel J, Bielik H, Yang A, Schwab JO, Shlevkov N, Schimpf R, Luderitz B, Lewalter T (2003) Amiodarone-associated “torsade de pointes”. Relevance of concomitant cardiovascular medication in a patient with atrial fibrillation and structural heart disease. Z Kardiol 92:889–892

    Article  PubMed  Google Scholar 

  18. Schumacher B, Jung W, Lewalter T, Vahlhaus C, Wolpert C, Lüderitz B (1999) Radiofrequency ablation of atrial flutter due to administration of class IC antiarrythmic drugs for atrial fibrillation. Am J Cardiol 83:710–713

    Article  PubMed  Google Scholar 

  19. Schumacher B, Lewalter T, Wolpert C, Jung W, Lüderitz B (1998) Radiofrequency catheter ablation of atrial flutter. J Cardiovasc Electrophysiol 9:139–146

    Google Scholar 

  20. Schumacher M, Olschewski M, Schulgen G (1991) Assessment of quality of life in clinical trials. Stat Med 10:1915–1930

    PubMed  Google Scholar 

  21. Tai CT, Ching CE, Lee SH,Chen YJ, Yu WC, Feng AN, Ding YA, Chang MS, Chen SA (1999) Persistent atrial flutter in patients treated for atrial fibrillation with amiodarone and propafenone: Electrophysiologic characteristics, radiofrequency catheter ablation, and risk prediction. J Cardiovasc Electrophysiol 10:1180–1187

    PubMed  Google Scholar 

  22. Van der Berg MP, Hassink RJ, Tuinenburg AE, van Sonderen EFLP, Lefrandt JD, Kam PJ, Gelder JC, Smit AJ, Sanderman R, Crijns HJGM (2001) Quality of life in patients with paroxysmal atrial fibrillation and its predictors: importance of the autonomic nervous system. Eur Heart J 22:247–253

    Article  PubMed  Google Scholar 

  23. Volkmann H (2000) Atrial fibrillation—frequency control or cardioversion? Z Kardiol 10:21–27

    Article  Google Scholar 

  24. Ware JE, Sherbourne CD (1992) The MOS 36-Item Short-Form Health Survey (SF-36): I. Conceptual framework and item selection. Med Car 30:473–483

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Medizinische Klinik und Poliklinik II, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany

    H. Bielik,  J. Schrickel,  N. Shlevkov,  A. Yang,  J. O. Schwab,  A. Bitzen &  B. Lüderitz

  2. Medizinische Klinik und Poliklinik II, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany

    T. Lewalter

Authors
  1. H. Bielik
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. Schrickel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. N. Shlevkov
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. J. O. Schwab
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. A. Bitzen
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. B. Lüderitz
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. T. Lewalter
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to T. Lewalter.

Additional information

The pharmacological and ablative hybrid therapy reduces the frequency and duration of symptomatic AF-episodes as well as AF-correlated symptoms and is associated with an improvement of quality of life

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bielik, H., Schrickel, J., Shlevkov, N. et al. Pharmacological and ablative hybrid therapy of atrial fibrillation. ZS Kardiologie 94, 564–569 (2005). https://doi.org/10.1007/s00392-005-0263-9

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00392-005-0263-9

Schlüsselwörter

Key words

Search

Navigation