Does Catheter Ablation Reduce Depression and Anxiety in Patients with Atrial Fibrillation?

Nearly one third of patients with AF are estimated to have severe depression and anxiety. Although some data indicate that catheter ablation might improve symptoms of depression and anxiety more than medical therapy in these patients, no randomized trials have examined this hypothesis.

In two specialist AF centers in Australia, 100 patients with persistent (49%) or paroxysmal AF were randomized to treatment with radiofrequency ablation or antiarrhythmic drugs. Patients and physicians were aware of the treatment assignment. The primary outcome was the combined Hospital Anxiety and Depression Scale (HADS) score at 12 months; secondary outcomes included individual anxiety and depression HADS scores and a separate depression score. The combined HADS score ranges from 0–42, with a score ≥7 indicating presence of psychological distress and a score ≥15 indicating severe psychological distress.

At baseline, 32% of all patients had severe psychological distress. At 12 months, compared with medical therapy, catheter ablation resulted in significant improvements in all measures of psychological distress as well as significantly decreased AF burden and symptom severity. In the ablation group, the mean combined HADS score decreased by approximately 5 points (from 12.3 to 7.6), which exceeded the minimal clinically important difference of 1.7. In the medical therapy group, the mean score decreased from 12.4 to 11.8.