Catheter ablation treatment for AF may improve severe psychological distress

In a recent JAMA study, researchers have said that those with a history of AF will likely benefit from catheter ablation to improve psychological symptoms of anxiety and depression. They mentioned catheter ablation to be superior in relieving psychological symptoms in addition to relieving physical symptoms of AF. They marked improvement in health-related quality of life, which has already been demonstrated in previous studies.

The impact of AF catheter ablation on mental health outcomes requires more data and research. This was further investigated in a recent study including 65 men and 31 women, with a mean age of 59. The study was conducted in two AF centres in Australia. [Randomized Evaluation of the Impact of Catheter Ablation on Psychological Distress in Atrial Fibrillation (REMEDIAL) Study]

The key points of the study are:

• A total of 100 patients were randomized, and 96 were analyzed.
• Fifty-two patients were in the catheter ablation group. (within one month of randomization).
• Forty-eight patients were in the medical therapy group (optimization of antiarrhythmic therapy to maintain such rhythm.
• The primary outcome was a combined hospital anxiety and depression scale (HADS) score at 12 months (range 0-42). The higher the score, the more severe the symptoms.
• Considering the ablation group, successful pulmonary vein isolation was achieved in all participants.
• At six months, the combined HADS score was lower in the ablation group vs. the medical group (8.2 vs. 11.9 [7.2]. At 12 months, it was 7.6 vs. 11.8, with a between-group difference of −4.17.
• The ablation group had a lower prevalence of severe psychological distress than the medical therapy group at six months and 12 months, with 14.2% vs. 34% and 10.2% vs. 31.9%.
• The anxiety HADS score at 6 and 12 months was 4.7 vs. 6.4 and 4.5 vs. 6.6.
• The depression HADS score at 3, 6 and 12 months was 3.7 vs. 5.2, 3.4 vs. 5.5 and 3.1 vs. 5.2 respectively.
• BDI-II score at 6 and 12 months was 7.2 vs. 11.5 and 6.6 vs. 10.9 respectively.
• The median AF burden in the ablation group was lower than in the medical therapy group, with recordings as 0% vs. 15.5%.

They said, “We noted Improvement of severe psychological distress as an additional benefit of catheter ablation for management of atrial fibrillation.”

The study has Limitations, such as the inability to rule out the possibility of a differential procedure-related placebo effect on study outcome, adherence to medical therapy among participants in the medical group was self-reported, and occult asymptomatic AF may have gone undetected.

Reference:

Al-Kaisey AM, Parameswaran R, Bryant C, et al. Atrial Fibrillation Catheter Ablation vs Medical Therapy and Psychological Distress: A Randomized Clinical Trial. JAMA. 2023;330(10):925–933. doi:10.1001/jama.2023.14685