Quality of life, symptoms and experiences of patients with an elevated body mass index undergoing catheter ablation for atrial fibrillation
Quality of life, symptoms, and experiences of patients with an elevated body mass index undergoing catheter ablation for atrial fibrillation Background Atrial fibrillation (AF) is the most common arrhythmia seen in clinical practice. Previous studies have demonstrated that AF may result in high symptom burden and a reduced quality of life (QoL). Rhythm control in the form of catheter ablation has become an established treatment option for AF. Certain risk factors are associated with the development and progression of AF, notably, an elevated body mass index (BMI). Emerging evidence suggests that risk factor modification in the management of AF is an important component of the patient pathway. The relationship between AF ablation, QoL, symptoms and BMI is poorly understood. We need to understand this further to provide more effective and targeted care. Previous studies concerning the influence of a raised BMI on QoL and symptoms after ablation have been contradictory. Qualitative research in this area has been limited. Aim This thesis aims to explore quality of life, symptoms, and experiences in patients with an elevated BMI undergoing catheter ablation for AF. Methods This was a single centre, mixed methods, observational cohort study of patients with a BMI >=25 who were eligible for first-time AF ablation. All eligible patients over a nine-month period were invited to take part. Quality of life and symptoms were assessed before ablation and at three and six months afterwards, using the SF-36 and Patient Perception Questionnaire, which are both validated tools previously used in this patient population. Multiple regression models were used to identify predictors for improvements in two of the QoL domains (Vitality and General Health) after ablation. Independent variables which included age, gender, BMI at baseline, classification of AF, left atrial volume index and rhythm control at 6 months were added to the regression model. At six months post ablation semi-structured interviews were undertaken to explore patient experiences of AF ablation and their immediate recovery period. Results Eighty-eight patients agreed to participate and 82 of those completed the study. The six that were excluded from analysis either had left atrial appendage thrombus on the day of the ablation and therefore did not undergo ablation or did not complete follow-up. A significant improvement was seen in all domains of quality of life after ablation (p<0.0005), at three and six months. Symptom burden also significantly improved at three and six months after ablation (p<0.0005). Multiple regression analysis demonstrated the predictors of improved Vitality (V) and General Health (GH) in QoL measures at six months were rhythm control at six months and baseline V and GH scores. Thematic analysis of participants experiences revealed four themes: personal well-being related to AF, care and treatments of AF, interplay of lifestyle and AF and living with AF in a pandemic. Conclusion This study has demonstrated that, despite a raised BMI, patients report significant QoL and symptomatic improvements after AF ablation. A multiple regression analysis demonstrated rhythm control at six-month predicts improvements in Vitality components of the SF-36. Framework analysis revealed four themes related to AF, treatments, lifestyle, and the pandemic. Overall, this study suggests that patients with a raised BMI have positive outcomes after catheter ablation for AF and that rhythm control is the most important factor that influences of improved quality of life. Furthermore, patient experiences of the AF diagnosis are challenging, ablation treatment is positive and lifestyle factors play an important role in looking to the future.
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