Evaluation of Changes in the Quality of Life Using the U22 Questionnaire after Cavotricuspid Isthmus Ablation
Abstract
Atrial tachyarrhythmias are the most common forms of heart rhythm disorders. According to literature sources, isolated atrial flutter (AFL) is observed in 88 people per 100,000 population. Most quality-of-life assessment methods have been developed and used primarily to assess atrial fibrillation. In this context, the U22 questionnaire becomes a significant protocol aimed at quantifying paroxysmal symptoms associated with tachyarrhythmias.
The aim. To evaluate changes in the quality of life in patients with typical AFL after radiofrequency ablation (RFA) and bidirectional conduction block through the cavotricuspid isthmus.
Materials and methods. The study is based on the analysis of the results of the treatment of a group of 135 patients at the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine in the period from 2014 to 2021. The patients had three follow-up examinations, which were subject to analysis and static processing: before RFA (n=135), after 1 month (n=122) and after 1 year (n=81). All the patients were interviewed concerning their arrhythmia-related symptoms, which were assessed according to the U22 protocol.
Results. Before the procedure, the patients noted a low level of well-being (4.3±1.0 points). During the follow-up visit 1 month after RFA, the patients rated their general condition during this period at 8.9±0.7 points. The registered changes were statistically significant compared to the initial state (p<0.0001). Thus, the radical elimination of AFL led to rapid improvement in the psycho-emotional and physical condition of the patients as early as within 1 month. Similar changes were observed during the assessment after 1 year, when the patients assessed their condition at 9.3±0.7 points (p<0.0001); there was statistically significant difference compared to the initial condition and the results at the first follow-up examination. These results confirm the stability of the positive trend during the medium-term follow-up.
Conclusions. The U22 questionnaire found symptomatic improvement in patients undergoing RFA of cavotricuspid isthmus. The U22 questionnaire can be considered as another, additional control tool for patients who underwent RFA. The peculiarity of its application is the specificity of the assessment of paroxysmal symptoms and complaints, which are specifically related to rhythm disturbances, and the possibility of a simple analysis of the dynamics for a long time after the intervention.
References
- Rehorn M, Sacks NC, Emden MR, Healey B, Preib MT, Cyr PL, et al. Prevalence and incidence of patients with paroxysmal supraventricular tachycardia in the United States. J Cardiovasc Electrophysiol. 2021;32(8):2199-2206. https://doi.org/10.1111/jce.15109
- Wang L, Ze F, Li J, Mi L, Han B, Niu H, et al. Trends of global burden of atrial fibrillation/flutter from Global Burden of Disease Study 2017. Heart. 2021;107(11):881-887. https://doi.org/10.1136/heartjnl-2020-317656
- Guichard JB, Naud P, Xiong F, Qi X, L’Heureux N, Hiram R, et al. Comparison of Atrial Remodeling Caused by Sustained Atrial Flutter Versus Atrial Fibrillation. J Am Coll Cardiol. 2020;76(4):374-388. https://doi.org/10.1016/j.jacc.2020.05.062
- Granada J, Uribe W, Chyou PH, Maassen K, Vierkant R, Smith PN, et al. Incidence and predictors of atrial flutter in the general population. J Am Coll Cardiol. 2000;36(7):2242-2246. https://doi.org/10.1016/s0735-1097(00)00982-7
- Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, et al. 2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J. 2021 Feb 1;42(5):373-498. https://doi.org/10.1093/eurheartj/ehaa612. Erratum in: Eur Heart J. 2021 Feb 1;42(5):507. Erratum in: Eur Heart J. 2021 Feb 1;42(5):546-547. Erratum in: Eur Heart J. 2021 Oct 21;42(40):4194
- Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, et al.; American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association. Circulation. 2019;139(10):e56-e528. https://doi.org/10.1161/CIR.0000000000000659. Erratum in: Circulation. 2020 Jan 14;141(2):e33.
- Diamant MJ, Andrade JG, Virani SA, Jhund PS, Petrie MC, Hawkins NM. Heart failure and atrial flutter: a systematic review of current knowledge and practices. ESC Heart Fail. 2021;8(6):4484-4496. https://doi.org/10.1002/ehf2.13526
- Biblo LA, Yuan Z, Quan KJ, Mackall JA, Rimm AA. Risk of stroke in patients with atrial flutter. Am J Cardiol. 2001;87(3):346-349, A9. https://doi.org/10.1016/S0002-9149(00)01374-6
- Nogami A, Kurita T, Abe H, Ando K, Ishikawa T, Imai K, et al.; JCS/JHRS Joint Working Group. JCS/JHRS 2019 Guideline on Non-Pharmacotherapy of Cardiac Arrhythmias. Circ J. 2021;85(7):1104-1244. https://doi.org/10.1253/circj.cj-20-0637
- Josephson ME. Clinical Cardiac Electrophysiology: techniques and interpretations. 4th ed. Philadelphia: Lippincott Williams & Wilkins;2008.
- Härdén M, Nyström B, Kulich K, Carlsson J, Bengtson A, Edvardsson N. Validity and reliability of a new, short symptom rating scale in patients with persistent atrial fibrillation. Health Qual Life Outcomes. 2009 Jul 15;7:65. https://doi.org/10.1186/1477-7525-7-65
- Moons P, Norekvål TM, Arbelo E, Borregaard B, Casadei B, Cosyns B, et al. Placing patient-reported outcomes at the centre of cardiovascular clinical practice: implications for quality of care and management. Eur Heart J. 2023;44(36):3405-3422. https://doi.org/10.1093/eurheartj/ehad514
- Blomström-Lundqvist C, Gizurarson S, Schwieler J, Jensen SM, Bergfeldt L, Kennebäck G, et al. Effect of Catheter Ablation vs Antiarrhythmic Medication on Quality of Life in Patients With Atrial Fibrillation: The CAPTAF Randomized Clinical Trial. JAMA. 2019;321(11):1059-1068. https://doi.org/10.1001/jama.2019.0335
- Spertus J, Dorian P, Bubien R, Lewis S, Godejohn D, Reynolds MR, et al. Development and Validation of the Atrial Fibrillation Effect on QualiTy-of-Life (AFEQT) Questionnaire in Patients With Atrial Fibrillation. Circ Arrhythm Electrophysiol. 2011;4(1):15-25. https://doi.org/10.1161/CIRCEP.110.958033
- Arribas F, Ormaetxe JM, Peinado R, Perulero N, Ramírez P, Badia X. Validation of the AF-QoL, a disease-specific quality of life questionnaire for patients with atrial fibrillation. Europace. 2010;12(3):364-370. https://doi.org/10.1093/europace/eup421
- Essebag V, Azizi Z, Alipour P, Khaykin Y, Leong-Sit P, Sarrazin JF, et al. Relationship between quality of life and burden of recurrent atrial fibrillation following ablation: CAPCOST multicentre cohort study. Europace. 2020;22(7):1017-1025. https://doi.org/10.1093/europace/euaa066
- Ladwig KH, Goette A, Atasoy S, Johar H. Psychological aspects of atrial fibrillation: A systematic narrative review: Impact on incidence, cognition, prognosis, and symptom perception. Curr Cardiol Rep. 2020 Sep 10;22(11):137. https://doi.org/10.1007/s11886-020-01396-w
- Mark DB, Anstrom KJ, Sheng S, Piccini JP, Baloch KN, Monahan KH, et al.; CABANA Investigators. Effect of Catheter Ablation vs Medical Therapy on Quality of Life Among Patients With Atrial Fibrillation: The CABANA Randomized Clinical Trial. JAMA. 2019;321(13):1275-1285. https://doi.org/10.1001/jama.2019.0692
- Höglund N, Rönn F, Tollefsen T, Jensen SM, Kesek M. U22 protocol as measure of symptomatic improvement after catheter ablation of atrial fibrillation. Ups J Med Sci. 2013;118(4):240-246. https://doi.org/10.3109/03009734.2013.821190
- Kesek M, Tollefsen T, Höglund N, Rönn F, Näslund U, Jensen SM. U22, a Protocol to Quantify Symptoms Associated with Supraventricular Tachycardia. Pacing Clin Electrophysiol. 2009;32 Suppl 1:S105-S108. https://doi.org/10.1111/j.1540-8159.2008.02263.x
- Issa ZF, Miller JM, Zipes DP, Bonow RO. Clinical Arrhythmology and Electrophysiology: A Companion to Braunwald’s Heart Disease. Philadelphia: Elsevier Science; 2009.
- Cosío FG. Atrial Flutter, Typical and Atypical: A Review. Arrhythm Electrophysiol Rev. 2017;6(2):55-62. https://doi.org/10.15420/aer.2017.5.2
- Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm. 2017;14(10):e275-e444. https://doi.org/10.1016/j.hrthm.2017.05.012
- Brugada J, Katritsis DG, Arbelo E, Arribas F, Bax JJ, Blomström-Lundqvist C, et al.; ESC Scientific Document Group. 2019 ESC Guidelines for the management of patients with supraventricular tachycardia The Task Force for the management of patients with supraventricular tachycardia of the European Society of Cardiology (ESC). Eur Heart J. 2020;41(5):655-720. https://doi.org/10.1093/eurheartj/ehz467. Erratum in: Eur Heart J. 2020 Nov 21;41(44):4258.
- Hlatky MA, Wang P. Improvement in Quality of Life After Radiofrequency Ablation. Pacing Clin Electrophysiol. 2006;29(4):341-342. https://doi.org/10.1111/j.1540-8159.2006.00350.x
- Barmano N, Charitakis E, Karlsson JE, Nystrom FH, Walfridsson H, Walfridsson U. Predictors of improvement in arrhythmia-specific symptoms and health-related quality of life after catheter ablation of atrial fibrillation. Clin Cardiol. 2019;42(2):247-255. https://doi.org/10.1002/clc.23134
- Li JH, Xie HY, Chen YQ, Cao ZJ, Tang QH, Guo XG, et al. Risk of New-Onset Atrial Fibrillation Post-cavotricuspid Isthmus Ablation in Typical Atrial Flutter Without History of Atrial Fibrillation. Front Physiol. 2021 Nov 30;12:763478. https://doi.org/10.3389/fphys.2021.763478
