Quality of life in patients with paroxysmal atrial fibrillation and its predictors: importance of the autonomic nervous system

Aims To determine the impact of paroxysmal atrial fibrillation on quality o f life and to determine the predictors of quality of life, particularly the role of symptomatology and autonomic function. Methods and Results The study group comprised 73 patients with paroxysmal a trial fibrillation (mean age 541 years, 51 males). On average, patients had a 3-year history of one paroxysm per week lasting 2 h. Quality of life was assessed using the SF-36 (Medical Outcomes Study Short-Form Health Survey) and compared with age-matched controls. Autonomic function was assessed us ing Holter monitoring with analysis of heart rate variability and autonomic function tests. Symptoms during paroxysms of atrial fibrillation were also scored. Multivariate analysis was performed to identify independent predic tors of quality of life. Quality of life scores were markedly lower in pati ents than in controls in four of the eight subscales (P<0.001): physical ro le function, emotional role function, vitality and general health. Structur al heart disease did not predict quality of life, whereas frequency of paro xysms was predictive only of physical role function. In contrast, autonomic variables (baroreflex-sensitivity, total power (heart rate variability), r esponse to deep breathing, 30-15 ratio (standing up)) were predictive in al l four respective subscales (P<0.05), depressed vagal function being predic tive of low scores. Symptoms, particularly severe perspiration, were also p redictive of low scores (P<0.05). Conclusions This study shows that paroxysmal atrial fibrillation causes sig nificant impairment of quality of life. Further, symptomatology and autonom ic function are important predictors of quality of life in this patient gro up. (C) 2001 The European Society of Cardiology.