Surgical Intervention for Irregular Heartbeat Found to Reduce Depression, Anxiety

An estimated 1 in 3 patients with atrial fibrillation, or irregular heartbeat, is affected by symptoms of depression and anxiety. A report appearing today in JAMA suggests that patients treated with catheter ablation—a minimally invasive treatment for atrial fibrillation—experienced greater reductions in symptoms of depression and anxiety than those patients treated with antiarrhythmic medications.

“This study highlights the negative impact of [atrial fibrillation] on patients’ mental health,” wrote Ahmed M. Al-Kaisey, M.B.Ch.B., of Royal Melbourne Hospital in Australia and colleagues. “[C]atheter ablation resulted in significant and sustained improvements in markers of psychological distress, further focusing attention on the importance of mental health assessment in patients with symptomatic [atrial fibrillation].”

The REMEDIAL (Randomized Evaluation of the Impact of Catheter Ablation on Psychological Distress in Atrial Fibrillation) study involved patients aged 18 to 80 who sought care for symptoms of atrial fibrillation between June 2018 and March 2021. Fifty-two of these patients were randomized to receive catheter ablation, and 48 received medication for their heart condition. The researchers assessed the participants using questionnaires at study enrollment and periodically throughout the 12-month study. These questionnaires included the Hospital Anxiety and Depression Scale (HADS) and the 36-item Short Form Health Survey (SF-36).

The mean combined HADS score for all participants at baseline was 12.72, and severe psychological distress (combined HADS score >15) was present in 31 of 96 participants (32%).

During 12 months of follow-up, 23 of 49 participants (47%) in the ablation group had documented atrial fibrillation compared with 45 of 47 (96%) in the medication group. A greater percentage of patients in the ablation group showed reductions in psychological distress over time, with 14.2% continuing to report severe psychological distress at six months and 10.2% reporting symptoms of psychological distress at 12 months. The percentage of patients in the medication group reported severe psychological distress was 34% at six months and 31.9% at 12 months.

Compared with the medication group, the ablation group had significantly lower mean anxiety HADS scores at 6 and 12 months as well as significantly lower mean depression HADS scores at 3 months, 6, and 12 months. Ablation was also associated with significantly lower symptoms of atrial fibrillation compared with medication therapy at 3, 6, and 12 months.

“The REMEDIAL trial sheds light on the question of what evidence-based [atrial fibrillation] treatment strategy to pursue from a patient-centered perspective,” wrote Julia Lurz, M.D., of Leipzig University and Karl-Heinz Ladwig, M.D., Ph.D., of the Technical University München in Germany in an accompanying editorial. “[A]ttentive clinical acumen is important to establish individually tailored treatment strategies. It is desirable for physicians to increase awareness of frequently concomitant depression, stress, and anxiety in patients with [atrial fibrillation]; to implement screening and assessment; and to initiate comprehensive and collaborative care.”

For related information, see the Psychiatric News article “Depression, Anxiety After Cardiac Arrest Linked to Long-Term Increased Risk of Death.”

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Alcohol Abuse Increases Risk of Multiple Cardiovascular Problems, Study Finds

Alcohol abuse increases the risk of heart problems to a similar degree as well-established cardiovascular risk factors such as hypertension and obesity, reports a study published Monday in the Journal of the American College of Cardiology. The study authors said that the findings suggest that efforts to mitigate alcohol abuse could lead to meaningful reductions of cardiovascular disease.

Researchers led by Gregory Marcus, M.D., of the University of California, San Francisco, analyzed a database of nearly 15 million California residents (aged 21 and older) who received ambulatory surgery, emergency care, or inpatient medical care in California between 2005 and 2009. The researchers then quantified the occurrences of alcohol abuse, cardiovascular outcomes, and other health data using International Classification of Diseases-9th Revision (ICD-9) and Current Procedural Terminology (CPT) codes given for each patient visit.

After adjusting for other potential risk factors, a diagnosis of alcohol abuse (identified in 268,084 patients, or 1.8%) was associated with a 2.14-fold increased risk of atrial fibrillation, a 1.45-fold increased risk of heart attack, and a 2.34-fold increased risk of congestive heart failure—magnitudes of risk that the authors noted are “similar to other well-established risk factors.”

They continued, “Although nearly all subgroups exhibited increased risk in the setting of alcohol abuse, those without a given risk factor for each outcome were disproportionately prone to enhanced cardiovascular risk.” However, while the relative risk of atrial fibrillation, heart attack, or heart failure rose significantly in this group, the absolute risk was still low. 

“The authors are to be commended for carefully differentiating between the relative risk and absolute risk of alcohol abuse—both individually and in combination with other risk factors—as such differences have clinical implications,” wrote Michael Criqui, M.D, M.P.H, and Isac Thomas, M.D., of the University of California, San Diego, in an accompanying editorial. 

Criqui and Thomas contrasted the findings by Marcus and colleagues with other research suggesting the health benefits of alcohol. Such studies, according to Criqui and Thomas, have tended to recruit more health-conscious participants and exclude heavy drinkers, so the results may be confounded by other lifestyle factors such as exercise and healthy eating.

“The current study likely presents a more valid picture of heavy drinking outcomes,” they wrote.

For related information, see the Psychiatric News article “Surgeon General Offers Next Steps for Tackling Substance Use.” 

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Researchers LInk Atrial Fibrillation to Cognitive Impairment

Reporting online in the June 5 Neurology, researchers at the University of Washington’s Cardiovascular Health Research Unit have determined that people with atrial fibrillation are likely to develop cognitive impairment or dementia at earlier ages than people without atrial fibrillation. They made that determination through a longitudinal analysis in the Cardiovascular Health Study, a community-based study of 5,888 men and women aged 65 and older, enrolled in 1989/90 or 1992/93. None of the participants had atrial fibrillation or a history of stroke at baseline.

Atrial fibrillation was identified by hospital discharge diagnosis codes and annual study ECGs. The main outcome was rate of decline in mean scores on the 100-point Modified Mini-Mental State Examination administered annually up to nine times. Of 5,150 participants who qualified for the analysis, 552 (10.7 percent) developed atrial fibrillation during seven years of follow-up. The authors hypothesized that embolic infarcts might be the cause of their findings, even though they excluded participants who experienced a stroke during the study. Cerebral hypoperfusion was also considered a possible etiology.

Read more about the causes of cognitive decline in elderly patients in Essentials of Geriatric Psychiatry, Second Edition, available from American Psychiatric Publishing here. 

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