Association between the quality of life and asymptomatic episodes of paroxysmal atrial fibrillation in the J-RHYTHM II study

Background: Paroxysmal atrial fibrillation (AF) patients have a reduced quality-of-life (QoL) despite the fact that the majority of AF episodes are asymptomatic. Asymptomatic AF is likely to be associated with substantial morbidity and mortality rates similar to those with symptomatic AF, whereas its effect on the QoL has not yet been clarified. Purpose: We studied the specific contribution of asymptomatic AF episodes to reducing the QoL. Methods: We assessed the QoL in 233 patients with paroxysmal AF and hypertension (age 64.9. ±. 9.7 years, 71% male) enrolled in the Japanese Rhythm Management Trial II for Atrial Fibrillation (J-RHYTHM II study) using an AF-specific QoL questionnaire (AFQLQ). The AFQLQ comprised 3 components: AFQLQ1, the frequency and duration of symptoms; AFQLQ2, severity of symptoms; and AFQLQ3, limitations in daily activities and mental anxiety. Higher scores indicated a better QoL. Each patient transmitted electrocardiograms for 30. s daily at a predetermined time as well as whenever arrhythmia-related symptoms were experienced. We examined the relationship between the 3 AFQLQ components and frequency of symptomatic and asymptomatic AF episodes (days/month) during 12 months of follow-up. Results: The symptomatic and asymptomatic AF frequencies were 0.9. ±. 3.1 days/month and 1.5. ±. 3.5 days/month, respectively. AFQLQ1 negatively correlated with the symptomatic AF frequency (Spearman's correlation coefficient: r= -0.332, p<. 0.001). AFQLQ2 and AFQLQ3 correlated with both the symptomatic AF frequency (r= -0.27, p<. 0.001 and r= -0.265, p<. 0.001, respectively) and asymptomatic AF frequency (r= -0.197, p<. 0.01 and r= -0.229, p<. 0.005, respectively). Conclusion: The asymptomatic AF episode frequency correlates with a reduced QoL in patients with paroxysmal AF, suggesting that there would be psychological benefits to its reduction.