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Patients with paroxysmal atrial fibrillation (AF) experience impaired quality of life (QoL) and psychological distress. Catheter ablation of AF can markedly improve QoL. However, the effect of catheter ablation of AF on psychological status is unknown.
Depression, anxiety, and QoL improve after catheter ablation in patients with paroxysmal AF.
A total of 166 consecutive patients with symptomatic paroxysmal AF were examined. Eighty-two patients (55 men, mean age 55.9 ± 6.1 y) underwent catheter ablation and 84 patients (58 men, mean age 57.2 ± 5.4 years) received antiarrhythmic drug (AAD) therapy. The Self-Rating Depression Scale, Self-Rating Anxiety Scale, and Medical Outcomes Survey 36-item Short-Form questionnaires were completed by these patients at baseline, and at 3, 6, 9, and 12 months of follow-up. Results in the ablation group were compared with those of the AAD group.
In the ablation group, 42.7% of patients showed symptoms of depression and 37.8% showed symptoms of anxiety, which were similar to those in the AAD group. Both groups similarly displayed reduced physical and mental QoL. Catheter ablation was effective in reducing symptoms of depression and anxiety and improving QoL, and it was superior to AAD therapy (all P < 0.001). Multiple regression analysis demonstrated that catheter ablation, no AF recurrence, avoidance of warfarin use, higher baseline depression and anxiety scores, and lower baseline QoL scores contributed to improvement of depression, anxiety, and QoL, respectively.
Catheter ablation is more effective for improving depression, anxiety, and QoL in patients with paroxysmal AF compared with AAD therapy. Clin. Cardiol. 2012 doi: 10.1002/clc.22039
This work was supported by grants from the National Science Foundation Council of China (No. 30971239 and No. 81070147) and the Beijing Natural Science Foundation (No. 7101004). The authors have no other funding, financial relationships, or conflicts of interest to disclose.
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Our study demonstrated that catheter ablation resulted in a sustainable reduction in psychological distress and an improvement in QoL for patients with symptomatic paroxysmal AF. Catheter ablation was a better treatment strategy than AAD therapy. Contributors to the improvement of depression, anxiety, and QoL included catheter ablation, avoidance of warfarin use, initial higher levels of depression and anxiety, and lower QoL.
Psychological distress in patients with coronary heart disease18–20 and heart failure21,22 has been studied extensively. To date, however, little is known regarding the extent of psychological distress in patients with AF.3,23 The present study revealed that high levels of self-reported symptoms of depression and anxiety and compromised QoL were present in individuals with symptomatic paroxysmal AF at baseline, which is consistent with previous studies.3,23 Patients with paroxysmal AF may often experience an impaired sense of well-being accompanied by psychological distress due to arrhythmia symptoms.24 It is conceivable that arrhythmia symptoms could increase the perception of AF burden and the likelihood that patients will suffer from affective disorders and disengage from daily physical activities. This may further evoke low mood and perpetuate a vicious circle of psychological distress, leading to poor mental and physical QoL. The current study found that levels of depression and anxiety were continuously reduced after the ablation procedure, with approximately one-fourth of the individuals in the ablation group reporting a dramatic relief in symptoms of depression or anxiety at the end of the study period. Moreover, PCS and MCS scores observed at the 6-month follow-up reached normal levels and remained at these levels during the next 6 months in the ablation group, consistent with observations reported by Pappone et al25 and Purerfellner et al.26 In contrast, no changes in the levels of depression and anxiety or QoL were observed in patients treated with AADs in our study. This outcome indicates that catheter ablation is an effective treatment strategy for AF patients in terms of reducing negative affectivity and enhancing QoL.
Many factors may have contributed to the better effectiveness of catheter ablation than AAD therapy. First, patients with paroxysmal AF could have suffered from arrhythmia symptoms that were so severe and disruptive that better rhythm control resulting from ablation was perceived as a more remarkable recovery than what had been achieved from the original medical treatment, with reduced levels of psychological distress and better QoL. Second, successful AF ablation enabled patients to experience such a great reduction in symptoms that they could become physically more active and enjoy their lives more fully, and subsequently regain a positive affective disposition. Although some asymptomatic recurrent atrial arrhythmias after the ablation procedure could not be monitored, adverse effects on depression and anxiety might be negligible. Third, successful AF ablation freed patients from AAD therapy and, therefore, helped avoid adverse effects from long-term AAD use. In addition, successful ablation enabled discontinuation of oral anticoagulation therapy, although this remains controversial.27–30 In general, patients treated medically need concomitant long-term anticoagulation with warfarin, which requires frequent international normalized ratio measurements and causes concern regarding an increased risk of bleeding, both of which may lead to negative affectivity and limit QoL improvement in patients.31
There are a few limitations in our study. The major limitation is the nonrandomized assignment of patients to different treatment strategies. The results could be affected by placebo effects. It is important to note that this study was conducted in subjects meeting strict inclusion criteria from a single center; therefore, the findings of this study may not apply to all AF populations because of possible geographic bias and high patient selection. The second limitation is that our study had a relatively small sample size. However, our finding of better effectiveness of catheter ablation compared with AADs was consistent and significant. The third limitation is that the follow-up period was relatively short. Longer follow-up periods might reveal additional changes in psychological factors. Interestingly, Wokhlu et al31 reported that AF ablation produced sustained QoL improvement after 2 years, even in patients with recurrence.