Impact of AF Ablation on Mental Health: REMEDIAL Trial

Besides improving physical symptoms and arrhythmia burden, AF ablation has a favorable impact on mental health and helps alleviate anxiety and depression, as shown by the results of the recently published REMEDIAL trial in JAMA Cardiology.

The impact of atrial fibrillation (AF) catheter ablation on mental health outcomes is not well understood. The Randomized Evaluation of the Impact of Catheter Ablation on Psychological Distress in Atrial Fibrillation (REMEDIAL) study was conducted to determine whether AF catheter ablation is associated with greater improvements in markers of psychological distress compared with medical therapy alone.

Study Overview

The study enrolled 100 patients with symptomatic AF, roughly half of whom (49%) had persistent AF. Patients randomized to ablation were treated with radiofrequency catheters, with successful pulmonary vein isolation achieved in all who underwent the procedure.

Outcomes

The primary outcome was the 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
• Beck Depression Inventory-II (BDI-II) score
• Arrhythmia recurrence and AF burden data

Results

During the 12-month follow-up period, patients who underwent ablation were significantly less likely than those treated with medical therapy alone to have documented AF on monitoring (47% vs 96%) and had a lower median AF burden (0 vs 15.5%).

Moreover, ablation-treated patients were less likely than controls to be taking an antiarrhythmic drug or a beta-blocker at 12 months.

For the primary endpoint, the mean HADS score at 12 months was significantly lower in the ablation arm, with a difference observed for both the anxiety and depression components.

Secondary outcomes also favored ablation—there was a lower proportion of patients reporting severe psychological distress (10.2% vs 31.9%) as well as a lower mean Beck Depression Inventory-II score and University of Toronto AF symptom severity score.

“The REMEDIAL trial nicely demonstrates what happens when AF symptom burden is reduced: depression and anxiety symptoms concomitantly decrease while measures of quality of life significantly improve, promoting the freedom of patients to engage in physical and social activities,” noted Lurz et al in an accompanying editorial.

It is expected that these results will provide more evidence for patients that AF ablation over the long term can potentially decrease the use of antiarrhythmic drugs, oral anticoagulants, and the reduction in AF burden can lead them to have a better quality of life.

Source

• JAMA. 2023;330(10):925-933. doi:10.1001/jama.2023.14685
• JAMA. 2023;330(10):919-920. doi:10.1001/jama.2023.6484