Rhythm Control Improves Health-Related Quality of Life in Atrial Fibrillation

Time from diagnosis to referral to a cardiology clinic does not affect quality of life in patients with atrial fibrillation.

Health-related quality of life shows clinical improvement with rhythm control therapy among patients with atrial fibrillation (AF), regardless of AF stage, according to study findings published in the American Heart Journal.

Researchers in Japan sought to evaluate the association between the time between AF diagnosis and referral to the cardiology clinic (AF stage) and health-related quality of life (HRQOL) outcomes following therapy with rhythm or rate control.

They conducted a retrospective analysis using the outpatient-based multicenter Keio Interhospital Cardiovascular Studies AF registry. This included 2070 patients at 11 outpatient clinics in the Tokyo metropolitan area newly diagnosed with AF within 5 years and stratified according to AF stage as early (AF duration ≤1 year) or late (AF duration >1 year).

HRQOL (assessed with the AF Effect on Quality-of-Life-overall summary [AFEQT-OS] score) information was collected at baseline and at 1 year following initial treatment. A generalized linear mixed model was used to adjust the change in AFEQT-OS score for patient characteristics. Initially, 2422 of 3313 patients in the registry had AFEQT-OS scores available, but 352 were excluded due to having AF duration greater than 5 years.

The researchers found the late AF group (n=426) was not as old as the early AF group (n=1644; late 64.4±10.6 years; early 68.5±11.1 years; P <.001). The late AF group did not experience as much heart failure as the early AF group (late 12.7%; early 19.9%; P <.001). The median AF duration in the early group was 12 days (IQR, 0-39) and 880 days (IQR, 588-1191) in the late group. The early AF group had more women and more comorbidities, including heart failure and coronary artery disease.

In our contemporary outpatient-based multicenter AF registry, rhythm control therapy provided clinically meaningful improvements in HRQoL, regardless of AF stage.

Slightly more than half of all patients were managed with rhythm control, and, of those, 73.8% received catheter ablation for AF within 1 year. Rhythm control, including catheter ablation, was a more likely treatment for patients with late AF than those with early AF.

The researchers observed that the adjusted changes in AFEQT-OS score 1 year after treatment in both groups were similar in patients with rhythm control (adjusted difference [SE], early, 8.4 [1.2]; late, 7.2 [1.4]; P =.15) or rate control (early, 4.0 [0.7]; late, 2.3 [1.4]; P =.16). They noted that patients receiving catheter ablation in both groups showed similar improvement in HRQOL (early, 10.2 [2.1]; late, 9.8 [2.4]; P =.78), and patients in both groups receiving antiarrhythmic drug (AAD) therapy alone showed a significant difference in HRQOL (early, 10.2 [1.4]; late, 3.4 [2.2]; P <.001).

There was no significant difference between groups in the incidence of clinical adverse events, and AF duration was not independently associated with clinical adverse events within 2 years, according to the Cox proportional-hazard model.

Study limitations include the nonrandomized observational design and that the exact onset of AF is often unclear. Additionally, rate or rhythm control treatment details prior to referral to cardiology services are unavailable, leading to possible mis-stratification, sampling bias, and lack of generalizability.

“In our contemporary outpatient-based multicenter AF registry, rhythm control therapy provided clinically meaningful improvements in HRQOL, regardless of AF stage,” the study authors wrote. “…the beneficial effects of catheter ablation on improvement in HRQOL were preserved even in patients with late AF, whereas the trend was not observed in patients receiving AAD therapy alone.” They urged that for patients with impaired HRQOL, treatment, especially catheter ablation, should not be deterred by AF duration.

Disclosure: This research was supported by Bayer Yakuhin, Ltd.

Some [or one] study author(s) declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Nakamaru R, Ikemura N, Spertus JA, et al. Rate versus rhythm control in patients with newly diagnosed atrial fibrillation: effects of the treatment timing on health status outcomes. Am Heart J. Published online September 10, 2022. doi:10.1016/j.ahj.2022.09.001