The impact of rate and rhythm control strategies on quality of life for patients with atrial fibrillation: a protocol for a systematic review
Authors: Uruthirakumar Powsiga , Surenthirakumaran Rajendra , Gooden Tiffany E. , Lip Gregory Y. H. , Thomas G. Neil , Moore David J. , Nirantharakumar Krishnarajah , Kumarendran Balachandran , Subaschandran Kumaran , Kaneshamoorthy Shribavan , Sheron Vethanayagam Antony , Guruparan Mahesan ,   on behalf of the NIHR Global Health Research Group on Atrial Fibrillation Management, Arasalingam Ajini , Beane Abi , Bensenor Isabela M. , Brocklehurst Peter , Cheng Kar Keung , Santos Itamar S. , El-Bouri Wahbi , Feng Mei , Goulart Alessandra C. , Greenfield Sheila , Guo Yutao , Gusso Gustavo , Haniffa Rashan , Humphreys Lindsey , Jolly Kate , Jowett Sue , Lancashire Emma , Lane Deirdre A. , Li Xuewen , Li Yan-guang , Lobban Trudie , Lotufo Paulo A. , Manseki-Holland Semira , Olmos Rodrigo D. , Paschoal Elisabete , Pirasanth Paskaran , Powsiga Uruthirakumar , Romagnolli Carla , Shantsila Alena , Shribavan Kanesamoorthy , Szmigin Isabelle , Subaschandren Kumaran , Tai Meihui , Varella Ana C. , Wang Hao , Wang Jingya , Zhang Hui , Zhong Jiaoyue 
Published: March 2023

Abstract

Background

Atrial fibrillation (AF) is the most common heart arrhythmia globally and it adversely affects the quality of life (QoL). Available rate and rhythm control strategies equally reduce mortality but may impact QoL differently. A number of systematic reviews have focused on the impact of specific strategies on QoL, though a 2006 review synthesized the evidence on the effect of all strategies on QoL, allowing for a clinically important comparison between the types of strategies. Many trials have been published since the review undertook the search in 2005; therefore, an update is needed. This systematic review aims to provide an update to the 2006 review on the impact of all rate and rhythm control strategies on QoL in people with AF.

Methods
The following four databases and three clinical trial registries will be searched for primary studies: CENTRAL, MEDLINE, Embase, CINAHL, WHO International Clinical Trials Registry Platform, ClinicalTrials.gov, and ClinicalTrialsRegister.eu. No language restriction will be applied. The search will be limited to 2004 or later publication year to allow overlap with the search conducted by the 2006 review authors. Any randomized control trial that reports the QoL of adult (≥ 18 years) AF patients following an eligible rate or rhythm control intervention will be eligible for inclusion. Eligible interventions (and comparators) include pacing, atrioventricular node junction and bundle of HIS ablation, pharmacological therapy, radio frequency catheter ablation, cryoablation, pulmonary vein isolation, maze operation, pace maker implantation, and defibrillator implantation. Two reviewers will independently screen for eligible studies, extract the data using a piloted tool, and assess bias by QoL outcome using the RoB 2 tool. The suitability of conducting a meta-analysis will be assessed by the clinical and methodology similarities of included studies. If it is feasible, standardized mean differences will be pooled using a random-effects model and assessed appropriately.

Discussion
The findings from this review will allow for meaningful comparisons between various rate and rhythm control strategies regarding their impact on QoL. This review will be useful for a wide range of stakeholders and will be crucial for optimizing the overall wellbeing of AF patients.

Systematic review registration
PROSPERO CRD42021290542