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CLINICAL RESEARCH: HEART RHYTHM DISORDER

Quality of Life and Exercise Performance in Patients in Sinus Rhythm Versus Persistent Atrial Fibrillation

A Veterans Affairs Cooperative Studies Program Substudy

Steven N. Singh, MD^_*,_*, X. Charlene Tang, PhD, MD, Bramah N. Singh, MD, DSc, Paul Dorian, MD^_**, Domenic J. Reda, PhD, Crystal L. Harris, PharmD, Ross D. Fletcher, MD^_*, Satish C. Sharma, MD^||, J. Edwin Atwood, MD, Alan K. Jacobson, MD^¶, H. Daniel Lewis, Jr, MD^#, Becky Lopez, RN, Dennis W. Raisch, PhD, Michael D. Ezekowitz, MD, PhD for the SAFE-T Investigators

^_* Department of Veterans Affairs Medical Center, Washington, DC
Department of Veterans Affairs Medical Center, Hines, Illinois
Department of Veterans Affairs Medical Center, West Los Angeles, California
Department of Veterans Affairs Medical Center, Albuquerque, New Mexico
^|| Department of Veterans Affairs Medical Center, Providence, Rhode Island
^¶ Department of Veterans Affairs Medical Center, Loma Linda, California
^# Department of Veterans Affairs Medical Center, Kansas City, Missouri
^_** Department of Veterans Affairs Medical Center, University of Toronto, Toronto, Canada
Department of Veterans Affairs Medical Center, Walter Reed Army Medical Center, Washington, DC
Department of Veterans Affairs Medical Center, Lankenau Institute for Medical Research, Philadelphia, Pennsylvania

Manuscript received October 13, 2005; revised manuscript received February 28, 2006, accepted March 7, 2006.

^_* Reprint requests and correspondence: Dr. Steven N. Singh, Veterans Affairs Medical Center of Washington, DC, 50 Irving Street NW, Washington, DC 20422. (Email: steve.singh{at}med.va.gov).

OBJECTIVES: The purpose of this study was to determine quality of life (QOL) and exercise performance (EP) in patients with persistent atrial fibrillation (AF) converted to sinus rhythm (SR) compared with those remaining in or reverting to AF.

BACKGROUND: Restoration of SR in patients with AF improving QOL and EP remains controversial.

METHODS: Patients with persistent AF were randomized double-blind to amiodarone, sotalol, or placebo. Those not achieving SR at day 28 were cardioverted and classified into SR or AF groups at 8 weeks (n = 624) and 1 year (n = 556). The QOL (SF-36), symptom checklist (SCL), specific activity scale (SAS), AF severity scale (AFSS), and EP were assessed.

RESULTS: Favorable changes were seen in SR patients at 8 weeks in physical functioning (p < 0.001), physical role limitations (p = 0.03), general health (p = 0.002), and vitality (p < 0.001), and at 1 year in general health (p = 0.007) and social functioning (p = 0.02). Changes in the scores for SCL severity (p = 0.01), functional capacity (p = 0.003), and AFSS symptom burden (p < 0.001) at 8 weeks and in SCL severity (p < 0.01) and AF symptom burden (p < 0.001) at 1 year showed significant improvements in SR versus AF. Symptomatic patients were more likely to have improvement. The EP in SR versus AF was greater from baseline to 8 weeks (p = 0.01) and to 1 year (p = 0.02). The EP correlated with physical functioning and functional capacity except in the AF group at 1 year.

CONCLUSIONS: In patients with persistent AF, restoration and maintenance of SR was associated with improvements in QOL measures and EP. There was a strong correlation between QOL measures and EP.

Abbreviations and Acronyms   AF = atrial fibrillation   AFSS = atrial fibrillation severity scale   BMI = body mass index   EP = exercise performance   LAD = left atrial dimension   LVEF = left ventricular ejection fraction   QOL = quality of life   SAS = specific activity scale   SCL = symptom checklist   SR = sinus rhythm

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