Abstract 118 Psychological assessment in patients with atrial fibrillation undergoing pulmonary vein isolation

Background: Atrial fibrillation (AF) is associated with anxiety, depression and chronic stress. A bidirectional relation exists between AF and these factors. AF is associated with anxiety, depression, chronic stress, and vice versa. Pulmonary vein isolation (PVI) is an established treatment of symptomatic AF. The purpose of this study was to evaluate potential effects of PVI on psychological factors.

Methods: In patients with AF scheduled for PVI, psychological and demographic factors were assessed by standardized and validated questionnaires at baseline and six months after PVI: Heart-focused anxiety (HFA) by the Cardiac Anxiety Questionnaire (CAQ), general anxiety and depression by the Hospital Anxiety and Depression Scale (HADS) and Health-related Quality of Life (HRQoL) by the Short Form Health Survey (SF-12).

Results: A total of 118 patients [age 64 ± 9 years, 69% male, left ventricular ejection fraction 57 ± 8%, 56% paroxysmal AF, CHA₂DS₂-VAsc-Score 2.9 ± 1.7] undergoing PVI [47% cryoablation, 53% radiofrequency ablation] were included. After PVI, significant improvements were observed in the mean total HFA score [1.71 ± 0.61 vs. 1.33 ± 0.63, p < 0.01], as well as in the CAQ sub-scores HFA attention, HFA fear and HFA avoidance scores [1.92 ± 0.71 vs. 1.48 ± 0.64, 1.78 ± 0.70 vs. 1.42 ± 0.77 and 1.34 ± 1.04 vs. 0.95 ± 0.94, p<0.01]. Subgroup analyses showed an association of improvement with freedom of documented AF recurrence. Mean scores of general anxiety and depression decreased significantly after PVI [8.76 ± 3.45 vs. 7.08 ± 3.06 and 7.95 ± 3.49 vs. 6.75 ± 3.90, p<0.01] in all subgroups regardless of AF recurrence. Further, both physical and mental composite scores of SF-12 increased significantly from baseline [40 ±11 vs. 44 ± 13 and 46 ± 13 vs. 49 ± 13, p = 0.27].

Conclusions: PVI for treatment of symptomatic AF results in a significant reduction of HFA. Improvements in general anxiety and depressive symptoms did not seem to be related only to rhythm control per se. Therefore, CAQ may represent a more specific evaluation tool as HADS in patients with AF.

Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02002-5
Psychological assessment in patients with atrial fibrillation undergoing pulmonary vein isolation
V. Pavlicek¹, S. Wedegärtner¹, D. Millenaar¹, J. Wintrich¹, I. Kindermann¹, M. Böhm¹, C. Ukena¹
¹Innere Medizin III - Kardiologie, Angiologie und internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar;
Background: Atrial fibrillation (AF) is associated with anxiety, depression and chronic stress. A bidirectional relation exists between AF and these factors. AF is associated with anxiety, depression, chronic stress, and vice versa. Pulmonary vein isolation (PVI) is an established treatment of symptomatic AF. The purpose of this study was to evaluate potential effects of PVI on psychological factors. Methods: In patients with AF scheduled for PVI, psychological and demographic factors were assessed by standardized and validated questionnaires at baseline and six months after PVI: Heart-focused anxiety (HFA) by the Cardiac Anxiety Questionnaire (CAQ), general anxiety and depression by the Hospital Anxiety and Depression Scale (HADS) and Health-related Quality of Life (HRQoL) by the Short Form Health Survey (SF-12). Results: A total of 118 patients [age 64 ± 9 years, 69% male, left ventricular ejection fraction 57 ± 8%, 56% paroxysmal AF, CHA₂DS₂-VAsc-Score 2.9 ± 1.7] undergoing PVI [47% cryoablation, 53% radiofrequency ablation] were included. After PVI, significant improvements were observed in the mean total HFA score [1.71 ± 0.61 vs. 1.33 ± 0.63, p < 0.01], as well as in the CAQ sub-scores HFA attention, HFA fear and HFA avoidance scores [1.92 ± 0.71 vs. 1.48 ± 0.64, 1.78 ± 0.70 vs. 1.42 ± 0.77 and 1.34 ± 1.04 vs. 0.95 ± 0.94, p<0.01]. Subgroup analyses showed an association of improvement with freedom of documented AF recurrence. Mean scores of general anxiety and depression decreased significantly after PVI [8.76 ± 3.45 vs. 7.08 ± 3.06 and 7.95 ± 3.49 vs. 6.75 ± 3.90, p<0.01] in all subgroups regardless of AF recurrence. Further, both physical and mental composite scores of SF-12 increased significantly from baseline [40 ±11 vs. 44 ± 13 and 46 ± 13 vs. 49 ± 13, p = 0.27]. Conclusions: PVI for treatment of symptomatic AF results in a significant reduction of HFA. Improvements in general anxiety and depressive symptoms did not seem to be related only to rhythm control per se. Therefore, CAQ may represent a more specific evaluation tool as HADS in patients with AF.
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