Patient-Reported Quality of Life After Stand-Alone and Concomitant Arrhythmia Surgery: A Systematic Review and Meta-Analysis

Objectives: Patient-reported quality of life (QOL) has become an important endpoint for arrhythmia surgery for atrial fibrillation (AF). While studies specifically evaluating the effect of arrhythmia surgery on QOL are scarce, we summarized current evidence of QOL following stand-alone and concomitant arrhythmia surgery for AF. Methods: All studies reporting on QOL using a validated QOL questionnaire of patients undergoing arrhythmia surgery for AF, both stand-alone and concomitant, were included in this systematic review. A meta-analysis was performed on inter-study heterogeneity of changes in QOL on 9 of 12 included studies who used the Short-Form (SF) 36 tool and meta-regression based on rhythm outcome after one year was executed. Finally, differences in QOL following stand-alone arrhythmia surgery and concomitant procedures were evaluated. Results: In standalone arrhythmia procedures, meta-regression showed significant improvements in patients who were in sinus rhythm compared to patients with recurrent AF after one year. This association between an improved QOL and the procedural effectiveness was also suggested in concomitant procedures. However, when comparing QOL of patients undergoing cardiac surgery with and without add-on surgical ablation for AF, only the variable ‘physical role’ demonstrated a significant improvement. Conclusions: In patients with AF, QOL improves after both stand-alone and concomitant arrhythmia surgery. In the concomitant group, this improvement can be attributed to both the cardiac procedure itself as well as the add-on arrhythmia surgery. On the other hand, both in standalone and concomitant procedures, the improvement in QOL seems to be related to the effectiveness of the procedure to maintain sinus rhythm after 12 months.