AF Ablation Partly a Placebo? Doctor-Patient Disagreement on AF Symptom Suggests Yes
雖然病患在進行心房顫動電燒手術對症狀通常會有改善，連續性心電圖也顯示心房顫動數量減少； 儘管有病患在電燒術後心律不整仍然持續，症狀也可能有所改善，所以病患的症狀和醫師的評估並不 一定相關聯、當中可能存在一定落差。
Dr Anna Björkenheim (Örebro University, Sweden) 在今年6 月 JACC: Clinical Electrophysiology 中發 表針對陣發性和持續性心房顫動病患接受電燒前、 後 6 個月、12 個月及24 個月對症狀做評估，方法分別用AF-specific symptom questionnaire (AF6) [ 病 患自行評估] 和 European Heart Rhythm Association (EHRA) classification 分析 [ 醫師評估], 心房顫動發作比率則經由植入連續性心電圖記錄器得知，當心房顫動發作比率少於 0.5% 定義為電燒成功。
結果在 54 個病患中，最大的進步在電燒後 6 個月，而相較於 EHRA classification、AF6 的改善更可持續至 12 個月，兩者相關聯性較低，但都與心房顫 動發作比率成正相關；無復發或低心房顫動發作比率的病患症狀大多有明顯改善，但在電燒後仍維持 較高心房顫動比率者同樣有所改善。 對以上發現意味著電燒術在心房顫動可能有安慰劑效應，但作者提出症狀的改善可能跟神經被阻斷有關，另一方面，症狀的改善能持續兩年以上實在很難單單用安慰劑效應來解釋。
The six items of AF6 summarize the most frequent problems named by patients in their contact with the nurse at the AF clinic.
Item 1 ｀breathing difficulties at rest'
Item 2 ｀breathing difficulties on exertion'
Item 3 ｀limitations in day-to-da y life due to atrial fibrillation´
Item 4 ｀feeling of discomfort due to atrial fibrillation'
Item 5 ｀tiredness due to atrial fibrillation'
Item 6 ｀worry/anxiety due to atrial fibrillation'
Patients choose a number on a Likert scale from 0 to 10, where 0 means no and 10 severe symptoms or difficulties, and the scores of the six questions are added into a single global score. The recall period for the instrument is the most recent 7 days.
Classification of AF-related symptoms (EHRA score) are as follows:
• EHRA I - ｀No symptoms'
• EHRA II - ｀Mild symptoms´; normal daily activity not affected
• EHRA III - ｀Severe symptoms´; normal daily activity affected
• EHRA IV - ｀Disabling symptoms´; normal daily activity discontinued (1)
Reference: AF Ablation Partly a Placebo? Doctor-Patient Disagreement on AF Symptom Suggests Yes - Medscape - Jul 12, 2017