The aim was to evaluate quality of life after procedure modification of electrophysiological substrate in patients with long standing atrial fibrillation (LSAF).
Materials and methods.The study included 160 patients with LSAF. The average age of the entire group was 60.4±9.5 (75.6% men, 24.4% women). Duration of arrhythmia history (6.3+3.4) year, the period of the last episode of AF (13.9±3.2) months. The use of combinations of antiarrhythmic drugs I, III class with a positive effect (mean (2.1±0.9) drugs). The average number of attempts cardioversion was 3.2±0.8 for 1 patient. Depending on the type of surgery performed, patients were divided into the following groups: I group (n=77) have been performed the Box Lesion procedure by C. Pappone, II group (n=83) have been performed staged procedure of electrophysiological substrate modifications (ESM) (linear PLV isolation, isolation of LA rear wall, ablation of mitral istmus, additional ablation lines on the anterior wall of the LA and coronary sinus). Surgeries have been performed on complex electrophysiological EP Workmate (St. Jude Medical, USA). Electroanatomial mapping was carried out in terms of the navigation system NavX (St. Jude Medical, USA).
Results and discussion. So, in the study group averaged PF score was lower at 53.8±8.8 than in the general population (p<0.0011) and the assessment of its prospects for treatment and GH 44.9±9.9 points (p<0.0011). Physical functioning index was 83.8 in healthy and 38.9±0.6 for patients before AF treatment; 3 months after the procedure, the figure was 68.7±0.9 for subgroup 1a, 69.9±0.9 for the subgroup 1b, 78.6±0.8 — subgroup 2a, and 81.7±0.6 for the subgroup 2b (p<0.05); 6 months 71.1±0.8, 76.1±0.8, 81.1±1.1, and 2b — 83.2±1.0, respectively (p<0.05). Index of role functioning was 80.9 in healthy subjects and 39.9±0.2 in patients before ablation (p<0.05); 3 months after the procedure the figure was 57.8±0.8 for subgroup 1a, 61.9±1.1 for the subgroup 1b, 69.6±1.0 — subgroup 2a, and 71.7±1.2 for the subgroup 2b (p<0.05); 6 months 59.3±0.9, 63.1±1.2, 72.8±1.1, and 74,6±1.1, respectively (p<0.05). General health was 72.1 in healthy subjects and 48.7±1.1 in patients before surgery treatment (p<0.05); 3 months after the procedure, the figure was 56.1±0.9 for subgroup 1a, 58.0±0.6 for subgroup 1b, 63.6±0.8 — subgroup 2a, and 65.8±1.1 for the subgroup 2b (p<0.05); 6 months 60.0±1.1, 65.1±1.0, 69.2±1.1, and 71.4±0.9 respectively (p<0.05).
Conclusions. Expanding spheres of influence contributes to the modification of more pathophysiological mechanisms involved in the maintenance of AF. Modification of electrophysiological substrate is the most appropriate treatment to improve the quality of life of patients with longstanding AF.