Assessment of long-term quality of life after cavotricuspid isthmus ablation for typical atrial flutter
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RESEARCH
Open Access
Assessment of long-term quality of life after cavotricuspid isthmus ablation for typical atrial flutter Pilar Cabanas-Grandío1*, Javier García-Seara1, Francisco Gude2, José Luis Martínez-Sande1, Xesús Alberte Fernández-López1 and José R González-Juanatey1
Abstract Background: Cavotricuspid isthmus (CTI) ablation is the treatment of choice in preventing recurrences of typical atrial flutter (AFl). However, little is known about long-term quality of life (QoL) after CTI ablation. Methods and results: From 01/2003 to 05/2005, 94 patients who consecutively underwent typical AFl ablation were included in the study. An SF-36 health questionnaire was self-administered before ablation and at follow-up. Transformed scores were calculated, adjusted for age and sex and then normalized and standardized for the Spanish population. Additionally, the minimal important differences (MID) were calculated to assess the smallest change in QoL that patients perceived as positive. A linear regression model was constructed to assess long-term QoL predictors. All SF-36 scales were lower than Spanish population scores. After a mean (SD) follow-up of 6.25 (0.5) years, all scales, except Bodily Pain, were higher than baseline. There was a significant difference for Physical Role (46.4 vs. 38.6, p < 0.001), Vitality (44.4 vs. 41.9, p = 0.038) and Mental Health (46.1 vs. 42.0, p = 0.001). However, only Physical Role achieved the criteria for MID. Recurrence of AFl, basal QoL, history of diabetes mellitus, atrial fibrillation and oral anticoagulation were predictors of long-term QoL. Conclusion: CTI ablation provides a significant improvement in long-term QoL for the dimensions of Physical Role, Vitality and Mental Health, although the smallest positive change that patients perceive as positive was only observed for Physical Role. Previous diabetes mellitus, atrial fibrillation, oral anticoagulation, basal QoL and AFl recurrence were determinants of a worse long-term QoL. Keywords: Typical atrial flutter, Ablation, Quality of life
Introduction Typical atrial flutter (AFl) is characterized by a macroreentry circuit around the tricuspid annulus; this circuit contains a propagating wave and an excitable gap. The anterior barrier of the activation wave is formed by the tricuspid annulus, while the posterior barrier is formed by the crista terminalis, the eustaquian ridge and its prolongation, the eustaquian valve [1]. The cavotricuspid isthmus (CTI) is a critical component of the circuit; its ablation is the technique available to block the circuit [1-3]. The success rate of this technique is currently high * Correspondence: [email protected] 1 Cardiology Department, University Clinical Hospital of Santiago de Compostela, Choupana, 15706 Santiago de Compostela, Spain Full list of author information is available at the end of the article
(90 to 100%) and complications are extremely rare. For these reasons, CTI ablation is a first-line treatment [4]. However, there is little information available about the quality of life
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