An estimated 1 in 3 patients with atrial fibrillation, or irregular heartbeat, is affected by symptoms of depression and anxiety. A report appearing today in JAMA suggests that patients treated with catheter ablation—a minimally invasive treatment for atrial fibrillation—experienced greater reductions in symptoms of depression and anxiety than those patients treated with antiarrhythmic medications.
“This study highlights the negative impact of [atrial fibrillation] on patients’ mental health,” wrote Ahmed M. Al-Kaisey, M.B.Ch.B., of Royal Melbourne Hospital in Australia and colleagues. “[C]atheter ablation resulted in significant and sustained improvements in markers of psychological distress, further focusing attention on the importance of mental health assessment in patients with symptomatic [atrial fibrillation].”
The REMEDIAL (Randomized Evaluation of the Impact of Catheter Ablation on Psychological Distress in Atrial Fibrillation) study involved patients aged 18 to 80 who sought care for symptoms of atrial fibrillation between June 2018 and March 2021. Fifty-two of these patients were randomized to receive catheter ablation, and 48 received medication for their heart condition. The researchers assessed the participants using questionnaires at study enrollment and periodically throughout the 12-month study. These questionnaires included the Hospital Anxiety and Depression Scale (HADS) and the 36-item Short Form Health Survey (SF-36).
The mean combined HADS score for all participants at baseline was 12.72, and severe psychological distress (combined HADS score >15) was present in 31 of 96 participants (32%).
During 12 months of follow-up, 23 of 49 participants (47%) in the ablation group had documented atrial fibrillation compared with 45 of 47 (96%) in the medication group. A greater percentage of patients in the ablation group showed reductions in psychological distress over time, with 14.2% continuing to report severe psychological distress at six months and 10.2% reporting symptoms of psychological distress at 12 months. The percentage of patients in the medication group reported severe psychological distress was 34% at six months and 31.9% at 12 months.
Compared with the medication group, the ablation group had significantly lower mean anxiety HADS scores at 6 and 12 months as well as significantly lower mean depression HADS scores at 3 months, 6, and 12 months. Ablation was also associated with significantly lower symptoms of atrial fibrillation compared with medication therapy at 3, 6, and 12 months.
“The REMEDIAL trial sheds light on the question of what evidence-based [atrial fibrillation] treatment strategy to pursue from a patient-centered perspective,” wrote Julia Lurz, M.D., of Leipzig University and Karl-Heinz Ladwig, M.D., Ph.D., of the Technical University München in Germany in an accompanying editorial. “[A]ttentive clinical acumen is important to establish individually tailored treatment strategies. It is desirable for physicians to increase awareness of frequently concomitant depression, stress, and anxiety in patients with [atrial fibrillation]; to implement screening and assessment; and to initiate comprehensive and collaborative care.”
For related information, see the Psychiatric News article “Depression, Anxiety After Cardiac Arrest Linked to Long-Term Increased Risk of Death.”
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