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- Björkenheim, Anna, 1980-, et al.
(författare)
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Assessment of Atrial Fibrillation–Specific Symptoms Before and 2 Years After Atrial Fibrillation Ablation : Do Patients and Physicians Differ in Their Perception of Symptom Relief?
- 2017
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Ingår i: JACC. - : Elsevier. - 2405-500X .- 2405-5018. ; 3:10, s. 1168-1176
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: The aim of this study was to evaluate patient-reported and physician-assessed atrial fibrillation (AF)–related symptoms after AF ablation.Background: Success of AF ablation is usually defined as freedom from AF, although symptom relief is often patients’ desire.Methods: Symptom relief was assessed as perceived by patients using the short, validated, AF-specific symptom questionnaire AF6 and as classified by physicians using the European Heart Rhythm Association (EHRA) classification at baseline and 6, 12, and 24 months after AF ablation. Recurrence of arrhythmia was documented by continuous electrocardiographic monitoring.Results: In total, 54 patients completed the 24-month follow-up. All 6 items on the AF6, AF6 sum score, and EHRA class improved significantly over time. The greatest improvement was seen during the first 6 months after ablation, but AF6 scores showed continued improvement up to 12 months, in contrast to EHRA class. There was a low correlation between AF6 score and EHRA class, but the predictive ability was low. Both AF6 scores and EHRA class were significantly correlated with AF burden at all times after ablation. A change of >9 points in AF6 sum score corresponded to a meaningful reduction in symptom severity.Conclusion: Patient-reported and physician-assessed outcomes were both useful in assessing symptom relief after AF ablation, although patient-reported outcomes were more sensitive tools. There was also a discrepancy between patient-reported and physician-assessed outcomes after ablation. Freedom from AF and a low AF burden most often resulted in a reduction of symptoms, but symptom relief also occurred despite little effect on the arrhythmia.
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| 3. |
- Björkenheim, Anna, 1980-, et al.
(författare)
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Patient-reported Outcomes In Relation To Continuously Monitored Rhythm Before And During Two Years After Atrial Fibrillation Ablation Using A Disease-specific And A Generic Instrument
- 2018
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Konferensbidrag (refereegranskat)abstract
- Background: Patients with AF have a lower health-related quality of life (HRQoL) than the general population.Objective: To assess the effect of AF ablation on AF-specific and generic patient-reported outcomes (PRO), compare it to a Swedish age- and sex-matched population and evaluate any association with the AF burden.Methods: Patients scheduled for AF ablation completed the generic SF-36 and the AF-specific PRO questionnaires before and six, 12 and 24 months after AF ablation. All patients underwent continuous ECG monitoring via an implantable loop recorder.Results: 54 patients completed the follow-up. After ablation, the generic SF-36 improved and both summary scores reached normative levels at 24 months, while physical functioning, role-physical and vitality remained lower than norms. Responders with an AF burden ≤0.5% at each visit after ablation reached the norms in all domains, while non-responders reached norms in only social functioning and MCS. All AF6 items and the sum score showed moderate to large improvement in both responders and non-responders. Higher AF burden was independently associated with poorer PCS and AF6 sum score. The AF sum score correlated with all SF-36 domains, but all AF6 items did not correlate with the SF-36 summary scores.Conclusion: The AF-specific AF6 questionnaire was more sensitive to changes in PRO related to AF burden than was the generic SF-36. Higher AF burden after ablation was associated with poorer AF-specific PRO and poorer generic physical but not mental health. Focusing on AF-specific symptoms and their impact on quality of life as an outcome after AF ablation is reasonable, as improving PROs is the main goal of AF ablation.
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| 4. |
- Björkenheim, Anna, 1980-, et al.
(författare)
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Patient-reported outcomes in relation to continuously monitored rhythm before and during two years after atrial fibrillation ablation using a disease-specific and a generic instrument
- 2018
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Konferensbidrag (refereegranskat)abstract
- Background: Atrial fibrillation (AF) ablation improves patient-reported outcomes (PROs), irrespective of mode of intermittent rhythm monitoring.Purpose: To evaluate the use of an AF-specific and a generic PRO instrument during continuous rhythm monitoring two years after AF ablation.Methods: Fifty-four patients completed the generic SF-36 and the AF-specific AF6 questionnaires before and six, 12 and 24 months after AF ablation. All patients underwent continuous ECG monitoring via an implantable loop recorder. The generic PRO scores were compared to those of a Swedish age- and sex-matched population.Results: After ablation both summary scores reached normative levels at 24 months, while physical functioning, role-physical and vitality remained lower than norms. Responders to ablation (AF burden <0.5%) reached the norms in all individual SF-36 domains, while non-responders (AF burden >0.5%) reached norms only in social functioning. All AF6 items and the sum score showed moderate to large improvement in both responders and non-responders, although responders had significantly lower scores 24 months after ablation. Higher AF burden was independently associated with poorer PCS and AF6 sum score.Conclusions: The AF-specific AF6 questionnaire was more sensitive to changes related to AF burden than the generic SF-36. Patients improved as documented by both instruments, but a higher AF burden after ablation was associated with poorer AF-specific PROs and poorer generic physical but not mental health. Our results support the use of an AF-specific instrument, alone or in combination with a generic instrument, to assess the effect of ablation.
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| 5. |
- Björkenheim, Anna, 1980-, et al.
(författare)
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Rhythm Control and its Relation to Symptoms During the First Two Years After Radiofrequency Ablation for Atrial Fibrillation
- 2016
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Ingår i: Pacing and Clinical Electrophysiology. - Hoboken, USA : Wiley-Blackwell Publishing Inc.. - 0147-8389 .- 1540-8159. ; 39:9, s. 914-925
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To evaluate rhythm control up to two years after AF ablation and its relation to reported symptoms.Background: The implantable loop recorder (ILR) continuously records the ECG, has an automatic AF detection algorithm and a possibility for patients to activate an ECG recording during symptoms.Methods: Fifty-seven patients (mean age 57±9 years, 60% male, 88% paroxysmal AF) underwent AF ablation following ILR implantation. Device data were downloaded at the ablation and three, six, 12, 18 and 24 months after ablation.Results: Fifty-four patients completed the two-year follow-up. Thirteen (24%) patients had no AF episodes detected by ILR during follow-up. Ten of 41 patients (24%) with AF recurrence were only detected by ILR and AF recurrences were detected earlier by ILR (P<0.001). The median AF burden in patients with AF recurrence was 5.7% (IQR 0.4-14.4) and was even lower in patients with AF only detected by ILR (P = 0.001). Forty-eight % of the patients indicated symptoms via the patient activator but 33% of those recordings were not due to AF. Early AF recurrence (within 3 months) was highly associated with later AF recurrence (P<0.001). AF burden >0.5% and longest >6h before the ablation were independent predictors of AF recurrence during intermittent but not continuous monitoring.Conclusions: After AF ablation, the AF burden was low throughout the 24 months follow-up. Nevertheless, symptoms were commonly indicated but one third of patient activated recordings did not show AF. Continuous monitoring was superior to intermittent follow-up in detecting AF episodes and assessing the AF burden.Clinical trial registration: URL: http://clinicaltrials.gov. Unique Identifier: NCT00697359.
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- Hallgren, Alexander, et al.
(författare)
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Subjective outcome related to donor site morbidity after sural nerve graft harvesting: a survey in 41 patients
- 2013
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Ingår i: BMC Surgery. - : Springer Science and Business Media LLC. - 1471-2482. ; 13
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Tidskriftsartikel (refereegranskat)abstract
- Background: The sural nerve is the most commonly used nerve for grafting severe nerve defects. Our aim was to evaluate subjective outcome in the lower leg after harvesting the sural nerve for grafting nerve defects. Methods: Forty-six patients were asked to fill in a questionnaire to describe symptoms from leg or foot, where the sural nerve has been harvested to reconstruct an injured major nerve trunk. The questionnaire, previously used in patients going through a nerve biopsy, consists of questions about loss of sensation, pain, cold intolerance, allodynia and present problems from the foot. The survey also contained questions (visual analogue scales; VAS) about disability from the reconstructed nerve trunk. Results: Forty-one out of 46 patients replied [35 males/6 females; age at reconstruction 23.0 years (10-72); median (min-max), reconstruction done 12 (1.2-39) years ago]. In most patients [37/41 cases (90%)], the sural nerve graft was used to reconstruct an injured nerve trunk in the upper extremity, mainly the median nerve [19/41 (46%)]. In 38/41 patients, loss of sensation, to a variable extent, in the skin area innervated by the sural nerve was noted. These problems persisted at follow up, but 19/41 noted that this area of sensory deficit had decreased over time. Few patients had pain and less than 1/3 had cold intolerance. Allodynia was present in half of the patients, but the majority of them considered that they had no or only slight problems from their foot. None of the patients in the study required painkillers. Eighty eight per cent would accept an additional sural nerve graft procedure if another nerve reconstruction procedure is necessary in the future. Conclusions: Harvesting of the sural nerve for reconstruction nerve injuries results in mild residual symptoms similar to those seen after a nerve biopsy; although nerve biopsy patients are less prone to undergo an additional biopsy.
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