PARIS, FRANCE. There is now ample evidence that patients with symptomatic atrial fibrillation (AF), particularly if paroxysmal (intermittent), experience a broad range of symptoms which adversely affect their quality of life (QoL). A group of French, Belgian and Italian researchers now reports that the QoL of lone afibbers can be markedly improved through treatment with controlled-release flecainide acetate (Flec CR).

Their study included 227 patients with symptomatic, paroxysmal AF with an average age of 65 years and 62% being male. Fifty-six percent of the group had controlled AF, that is, no more than one episode per 6 months prior to enrolment, while the remaining 44% had uncontrolled AF defined as having experienced two or more symptomatic episodes during the 6 months pre-enrolment. Eighty percent of the patients in the controlled group were taking regular (non time-release) flecainide at baseline vs. 2% in the uncontrolled group. A major difference between the two groups was the time since diagnosis which averaged less than one month for 4% in the controlled group vs. 54% in the uncontrolled group.

All study participants completed the Medical Outcomes Study 36-Item Short-Form Health Survey (MOS SF-36) at baseline and after 12, 24 and 48 weeks treatment with 100 – 200 mg/day of Flec CR. The MOS SF-36 contains questions concerning:

• Physical functioning
• Role limitations due to physical problems (role physical)
• Bodily pain
• General health
• Vitality
• Role limitations due to emotional problems (role emotional)
• Social functioning
• Mental health

A comparison of scores at baseline showed that controlled afibbers had a score very similar to that of a matched general population sample except for role emotional and mental health scores which tended to be worse in the controlled group. Baseline scores in the uncontrolled group, however, were worse in all categories than those for both the reference group and the controlled group. The role physical, role emotional and mental health scores were particularly low in the uncontrolled group.

After 24 weeks of treatment with Flec CR, the scores in the uncontrolled group approached those in the controlled group and by week 48 were essentially equivalent. Thirty-eight percent of patients experienced at least one AF episode during the study period (32.5% in the controlled group vs. 46.9% in the uncontrolled group). However, these episodes were substantially less symptomatic in the uncontrolled group than those experienced prior to therapy with Flec CR.

Overall, the most frequent symptoms accompanying AF episodes were palpitations (85%), fatigue (31%), breathing problems (21%), and chest pain (12%). Dizziness, weakness and feeling faint were less common symptoms reported by less than 10% of participants.

The researchers conclude that treatment with controlled-release flecainide acetate improves quality of life scores to the level reported for the general, afib-free population.

Guedon-Moreau, L, et al. Impact of the control of symptomatic paroxysmal atrial fibrillation on health-related quality of life. Europace Vol. 12, 2010, pp. 634-42

Editor's comment: This study clearly shows that uncontrolled AF is associated with a significant deterioration of quality of life and that attainment of a prolonged period of normal sinus rhythm results in a very significant increase in QoL scores.