Catheter ablation procedures may help improve the mental health of patients presenting with symptomatic atrial fibrillation (AFib), according to a new analysis published in JAMA.[1] The study’s authors identified key reductions in symptoms associated with both anxiety and depression.
The Randomized Evaluation of the Impact of Catheter Ablation on Psychological Distress in AFib (REMEDIAL) study included data from 96 patients referred for AFib treatment from June 2018 to March 2020. The mean age was 59 years old, and persistent AFib was seen in 49% of patients. Any patients presenting with severe depression were excluded. While 49 patients underwent catheter ablation, the remaining 47 patients were treated with traditional medical treatments, including antiarrhythmic drug therapy. All ablation procedures involved the use of general anesthesia and radiofrequency ablation.
“The goal of AFib ablation was persistent isolation of all pulmonary veins,” wrote first author Ahmed Al-Kaisey, MBChB, a cardiologist with Royal Melbourne Hospital in Australia, and colleagues. “Additional ablation at the index procedure was performed at the physician’s discretion.”
At baseline, three months, six months and one year, each patient filled out multiple questionnaires designed to measure psychological distress. The Hospital Anxiety and Depression Scale (HADS), for instance, includes seven questions focused on anxiety and another seven focused on depression. An overall combined HADS score from seven to 14 is viewed as a sign of “the presence of psychological distress,” and a combined HADS score of 15 or higher is viewed as a sign of “severe psychological distress.”
The Beck Depression Inventory-II (BDI-II) score, meanwhile, uses a total of 21 questions to track symptoms of depression and screen for potential signs of self-harm.
Overall, the mean combined HADS score at baseline was 12.71, which falls in the “psychological distress” range of seven to 14. In addition, 32% of patients fell in the “severe psychological distress” range of 15 or higher. After each patient underwent treatment for their AFib, however, the ablation group was associated with a “significantly lower” mean combined HADS score after six months (8.2 vs. 11.9) and after one year (7.6 vs. 11.8). These improved combined HADS scores were seen in both male and female patients.
Patients in the ablation group also had “significantly lower” mean BDI-II scores after six months and 12 years, the authors added.
“To the authors’ knowledge, this is the first randomized study assessing the impact of catheter ablation on the psychological symptoms of anxiety and depression as a primary end point,” the authors wrote. “This study highlights the negative impact of AFib on patients’ mental health. Compared with medical therapy, catheter 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 AFib.”
Click here to read the full study in JAMA, a journal from the American Medical Association.
Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.