Atrial Fibrillation Catheter Ablation vs Medical Therapy in Terms of Psychological Distress
abstract
This abstract is available on the publisher's site.
Access this abstract nowIMPORTANCE
The impact of atrial fibrillation (AF) catheter ablation on mental health outcomes is not well understood.
OBJECTIVE
To determine whether AF catheter ablation is associated with greater improvements in markers of psychological distress compared with medical therapy alone.
DESIGN, SETTING, AND PARTICIPANTS
The Randomized Evaluation of the Impact of Catheter Ablation on Psychological Distress in Atrial Fibrillation (REMEDIAL) study was a randomized trial of symptomatic participants conducted in 2 AF centers in Australia between June 2018 and March 2021.
INTERVENTIONS
Participants were randomized to receive AF catheter ablation (n = 52) or medical therapy (n = 48).
MAIN OUTCOMES AND MEASURES
The primary outcome was Hospital Anxiety and Depression Scale (HADS) score at 12 months. Secondary outcomes included follow-up assessments of prevalence of severe psychological distress (HADS score >15), anxiety HADS score, depression HADS score, and Beck Depression Inventory-II (BDI-II) score. Arrhythmia recurrence and AF burden data were also analyzed.
RESULTS
A total of 100 participants were randomized (mean age, 59 [12] years; 31 [32%] women; 54% with paroxysmal AF). Successful pulmonary vein isolation was achieved in all participants in the ablation group. The combined HADS score was lower in the ablation group vs the medical group at 6 months (8.2 [5.4] vs 11.9 [7.2]; P = .006) and at 12 months (7.6 [5.3] vs 11.8 [8.6]; between-group difference, -4.17 [95% CI, -7.04 to -1.31]; P = .005). Similarly, the prevalence of severe psychological distress was lower in the ablation group vs the medical therapy group at 6 months (14.2% vs 34%; P = .02) and at 12 months (10.2% vs 31.9%; P = .01), as was the anxiety HADS score at 6 months (4.7 [3.2] vs 6.4 [3.9]; P = .02) and 12 months (4.5 [3.3] vs 6.6 [4.8]; P = .02); the depression HADS score at 3 months (3.7 [2.6] vs 5.2 [4.0]; P = .047), 6 months (3.4 [2.7] vs 5.5 [3.9]; P = .004), and 12 months (3.1 [2.6] vs 5.2 [3.9]; P = .004); and the BDI-II score at 6 months (7.2 [6.1] vs 11.5 [9.0]; P = .01) and 12 months (6.6 [7.2] vs 10.9 [8.2]; P = .01). The median (IQR) AF burden in the ablation group was lower than in the medical therapy group (0% [0%-3.22%] vs 15.5% [1.0%-45.9%]; P < .001).
CONCLUSION AND RELEVANCE
In this trial of participants with symptomatic AF, improvement in psychological symptoms of anxiety and depression was observed with catheter ablation, but not medical therapy.
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Additional Info
Atrial Fibrillation Catheter Ablation vs Medical Therapy and Psychological Distress: A Randomized Clinical Trial
JAMA 2023 Sep 12;330(10)925-933, AM Al-Kaisey, R Parameswaran, C Bryant, RD Anderson, J Hawson, D Chieng, L Segan, A Voskoboinik, H Sugumar, GR Wong, S Finch, SA Joseph, A McLellan, LH Ling, J Morton, P Sparks, P Sanders, G Lee, PM Kistler, JM KalmanFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.