Heart-Focused Anxiety, General Anxiety, Depression and Health-Related Quality of Life in Patients with Atrial Fibrillation Undergoing Pulmonary Vein Isolation

Pavlicek, Valérie; Wedegärtner, Sonja Maria; Millenaar, Dominic; Wintrich, Jan; Böhm, Michael; Kindermann, Ingrid; Ukena, Christian

doi:10.3390/jcm11071751

Cited by 7 publications

(3 citation statements)

References 28 publications

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“…However, there are no randomized data to date showing reduction in major cardiovascular events in patients treated with ablation compared with medical therapy . Furthermore, medical therapy retains a class 1A recommendation in international guidelines for maintenance of sinus rhythm in patients with atrial fibrillation . For these reasons, it was considered to be ethical to randomize consenting patients to undergo a 12-month trial of optimized medical therapy.…”

Section: Discussionmentioning

confidence: 99%

“…In regard to ethical consideration of treating symptomatic patients with AF with medical therapy, there are no randomized data showing reduction in major cardiovascular events in patients treated with ablation compared with medical therapy . Furthermore, medical therapy retains a class 1A recommendation in international guidelines for maintenance of sinus rhythm in patients with AF . Nevertheless, at the completion of 12 months of follow-up, all patients in the medical therapy group were offered an ablation.…”

Section: Methodsmentioning

confidence: 99%

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Atrial Fibrillation Catheter Ablation vs Medical Therapy and Psychological Distress

Al-Kaisey,

Parameswaran,

Bryant

et al. 2023

JAMA

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ImportanceThe impact of atrial fibrillation (AF) catheter ablation on mental health outcomes is not well understood.ObjectiveTo determine whether AF catheter ablation is associated with greater improvements in markers of psychological distress compared with medical therapy alone.Design, Setting, and ParticipantsThe Randomized Evaluation of the Impact of Catheter Ablation on Psychological Distress in Atrial Fibrillation (REMEDIAL) study was a randomized trial of symptomatic participants conducted in 2 AF centers in Australia between June 2018 and March 2021.InterventionsParticipants were randomized to receive AF catheter ablation (n = 52) or medical therapy (n = 48).Main Outcomes and MeasuresThe primary outcome was Hospital Anxiety and Depression Scale (HADS) score at 12 months. Secondary outcomes included follow-up assessments of prevalence of severe psychological distress (HADS score &gt;15), anxiety HADS score, depression HADS score, and Beck Depression Inventory-II (BDI-II) score. Arrhythmia recurrence and AF burden data were also analyzed.ResultsA total of 100 participants were randomized (mean age, 59 [12] years; 31 [32%] women; 54% with paroxysmal AF). Successful pulmonary vein isolation was achieved in all participants in the ablation group. The combined HADS score was lower in the ablation group vs the medical group at 6 months (8.2 [5.4] vs 11.9 [7.2]; P = .006) and at 12 months (7.6 [5.3] vs 11.8 [8.6]; between-group difference, −4.17 [95% CI, −7.04 to −1.31]; P = .005). Similarly, the prevalence of severe psychological distress was lower in the ablation group vs the medical therapy group at 6 months (14.2% vs 34%; P = .02) and at 12 months (10.2% vs 31.9%; P = .01), as was the anxiety HADS score at 6 months (4.7 [3.2] vs 6.4 [3.9]; P = .02) and 12 months (4.5 [3.3] vs 6.6 [4.8]; P = .02); the depression HADS score at 3 months (3.7 [2.6] vs 5.2 [4.0]; P = .047), 6 months (3.4 [2.7] vs 5.5 [3.9]; P = .004), and 12 months (3.1 [2.6] vs 5.2 [3.9]; P = .004); and the BDI-II score at 6 months (7.2 [6.1] vs 11.5 [9.0]; P = .01) and 12 months (6.6 [7.2] vs 10.9 [8.2]; P = .01). The median (IQR) AF burden in the ablation group was lower than in the medical therapy group (0% [0%-3.22%] vs 15.5% [1.0%-45.9%]; P &lt; .001).Conclusion and RelevanceIn this trial of participants with symptomatic AF, improvement in psychological symptoms of anxiety and depression was observed with catheter ablation, but not medical therapy.Trial RegistrationANZCTR Identifier: ACTRN12618000062224

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Atrial Fibrillation Catheter Ablation vs Medical Therapy and Psychological Distress

Al-Kaisey,

Parameswaran,

Bryant

et al. 2023

JAMA

View full text Add to dashboard Cite

show abstract

“…Thus, potential disappointment about treatment assignment in the medical therapy group and high expectations for the benefits of the invasive procedure in the intervention (ablation) group could have fueled the success of catheter ablation also in terms of mental health criteria. In line with this, it not surprising that depression and anxiety improved after catheter ablation irrespective of AF recurrences …”

mentioning

confidence: 99%