Catheter Ablation Superior in Relieving Anxiety/Depression in A-Fib Patients and Improves Quality of Life

In an important study from Australia, Dr. Jonathan Kalman and colleagues from Royal Melbourne Hospital found that catheter ablation was better than medical drug therapy alone in relieving an A-Fib patient’s psychological distress as well as improving physical symptoms and quality of life.

Psychological And Emotional Symptoms of A-Fib

A-Fib often has psychological and emotional symptoms as well as physical. (See my post: Coping with the Fear and Anxiety of Atrial Fibrillation.) These psychological and emotional symptoms make physical symptoms worse.

Psychological distress conditions are independent risk factors for adverse cardiovascular outcomes…and promote A-Fib recurrence, according to an editorial accompanying this Journal of American Medical Assoc. (JAMA) research report, Atrial Fibrillation Catheter Ablation vs Medical Therapy and Psychological Distress: A Randomized Clinical Trial.  (Drs. Julia Lurz of Heart Center Leipzig and Karl-Heinz Ladwig of Technical University Munich, Germany). The editorialists urged more awareness of and screening for depression, stress, and anxiety in A-Fib patients.

Randomized Trial

In their study, researchers randomized patients with symptomatic A-Fib to receive either catheter ablation (n=52) or antiarrhythmic medical (drug) therapy (n=48). Patients were followed for 12 months. Ablation patients underwent RF ablation to isolate all pulmonary veins which was achieved in all participants. Additional ablation targets were allowed at the operator’s discretion. A-Fib burden was assessed twice-daily.

Psychological Distress Reduced

Anxiety and depression were significantly reduced in the ablation group.

•  Prevalence of severe psychological distress at 12 months: 10.2% after ablation vs 31.9% after medical (drug) therapy
•  Hospital Anxiety and Depression Scale (HADS) scores: Anxiety 7.6 vs 11.8 points, and Depression 3.1 vs 5.2 points
•  Depression on Beck Depression Inventory-II score was 6.6 vs 10.9 points

In addition, patients were left with an A-Fib burden averaging 0% vs 15.5% after medical (drug) therapy.

Researchers found “…Low AF burden, absence of AF recurrence, and cessation of [antiarrhythmic drug] therapy were all significantly associated with improvements in psychological distress.” And “improvement in psychological symptoms of anxiety and depression was observed with catheter ablation, but not medical therapy.”

Editor’s Comments

Catheter Ablation Reduces Psychological Distress: This is an important, ground-breaking study for us A-Fib patients. Feelings of anxiety, fear, worry, confusion, frustration, depression, and anger often come along with A-Fib and can make our physical symptoms worse. But this Australian study shows that catheter ablation reduces psychological distress by a huge margin compared to medical therapy. (10.2% vs 31.9%).

Doctors May Ignore the Psychological Effects of A-Fib: But all too often when you go to a doctor for A-Fib, they ignore or minimize the psychological and emotional aspects of A-Fib. They are more concerned about your physical symptoms. If that’s the case for you, you need to find on your own a therapist who will acknowledge and treat your psychological distress, even if it might involve antidepressants.

Get a Catheter Ablation for Your Mental Health: This Australian study is all the more reason, if you have A-Fib, to get a catheter ablation as reasonably soon as possible. You will not only feel better with less or no A-Fib burden, but your mental and emotional health will be significantly improved.

NOTE: Dr. Kalman, after reading this report, sent me the following comment, “AF natural history is very variable, and many patients can go for long periods of time with only occasional episodes and minimal Quality of Life impact. For these patients I would not recommend an early ablation… .”

Click image to go to: “The Mental Games that A-Fib Plays―Anthony Offers Ways to Cope”

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