Comparing the effects of pulsed and radiofrequency catheter ablation on quality of life, anxiety, and depression of patients with paroxysmal supraventricular tachycardia: a single-center, randomized, single-blind, standard-controlled trial.

BACKGROUND: Radiofrequency catheter ablation (RFCA) may lead to decreased quality of life (QOL) and increased anxiety and depression in patients with paroxysmal supraventricular tachycardia (PSVT), possibly due to the lack of selectivity of the ablation tissue and the long ablation time. In recent years, pulsed field ablation (PFA) has been used for the first time in China to treat PSVT patients because of its ability to ablate abnormal tissue sites in a precise and transient manner. This study was conducted to compare the effects of PFA and RFCA on QOL and psychological symptoms of PSVT patients. METHODS: We have designed a single-center, randomized, single-blind, standard-controlled trial. A total of 50 participants who met the eligibility criteria would be randomly allocated into the PFA group or RFCA group in a 1:1 ratio. All participants were assessed using the 36-Item Short-Form Health Survey (SF-36) and the Hospital Anxiety and Depression Scale (HADS) at pre-procedure (T0), post-procedure (T1), and 3 months post-procedure (T2). The SPSS 21.0 software was used to analyze the data through Wilcoxon and Fisher's exact tests and repeated measures ANOVA. RESULTS: Twenty-five in the PFA group and 24 in the RFCA group completed the trial. SF-36: (1) Between-group comparison: At T1, PFA group had significantly higher SF-36 scores on physiological function (PF) and general health (GH) than RFCA group, with a treatment difference of 5.61 points and 18.51 points(P < 0.05). (2) Within-group comparison: We found that in the PFA and RFCA groups, T2 showed significant improvement in the remaining 6 subscales of the SF-36 scale compared to T1 and T0 (P < 0.05), except for body pain (BP) and social function (SF) scores. HADS: (1) Between-group comparison: no significant difference (P > 0.05). (2) Within-group comparison: The HADS scores of the PFA and RFCA groups were statistically significant at T2 compared to T0 and T1 (P < 0.05). CONCLUSIONS: Our study provided new and meaningful evidence that PFA was effective in significantly improving QOL and decreasing anxiety and depression in PFA patients. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR2200060272.

Sustained quality-of-life improvement post-cryoballoon ablation in patients with paroxysmal atrial fibrillation: Results from the STOP-AF Post-Approval Study.

BACKGROUND: Pulmonary vein isolation by catheter ablation is a class IA indication for the treatment of symptomatic, drug-refractory, paroxysmal atrial fibrillation (PAF). Quality of life (QoL) has been identified as a clinically meaningful endpoint but has not been comprehensively evaluated to date. OBJECTIVE: The purpose of this study was to evaluate the effects of cryoballoon ablation on long-term QoL. METHODS: As part of the STOP-AF Post-Approval Study, QoL was assessed using the Short Form-12 Health Survey (SF-12) along with evaluation of arrhythmia-related symptoms through 36 months. A multivariate linear mixed effects regression was used to determine the association between atrial fibrillation symptoms and QoL scores, and univariate linear regressions were used to assess predictors of 36-month change in QoL scores. RESULTS: Three hundred thirty-five subjects fully completed SF-12 forms at baseline, with 319, 308, 291, and 278 subjects completing surveys at the subsequent follow-up visits. Both physical and mental composite scores increased significantly from baseline (P <.001), and all arrhythmia symptoms significantly decreased from baseline (P <.001), with 62.0% of subjects reporting no symptoms at 6 months compared to 5.7% at baseline (P <.001). Presence of dyspnea and fatigue at baseline were univariate predictors of physical QoL improvement (P = .045 and 0.0497, respectively), whereas each year of age and each year of PAF duration were predictors of a decrease in mental QoL (P = .014 and .04, respectively). CONCLUSION: Cryoballoon ablation for treatment of PAF results in a significant, and sustained, QoL improvement. The observed improvement in physical and mental health likely may be mediated by a reduction in symptom and arrhythmia burden.

IMPACT OF RADIOFREQUENCY CATHETER ABLATION ON HEALTH-RELATED QUALITY OF LIFE ASSESSED BY THE SF-36 QUESTIONNAIRE IN PATIENTS WITH PAROXYSMAL SUPRAVENTRICULAR TACHYCARDIA.

The aim of the study was to investigate the effect of catheter ablation on different aspects of health-related quality of life in association with patients' age, gender and the type of paroxysmal supraventricular tachycardia. We investigated 70 consecutive patients with paroxysmal supraventricular tachycardia (AV Nodal Reentrant Tachycardia (AVNRT), AV Reentrant Tachycardia (AVRT) or Atrial Tachycardia (AT)) who underwent a catheter ablation. The patients were asked to fill out the short form (SF-36) health questionnaire before the ablation on the day of the procedure and after 3 months of a successful catheter ablation and eight health concept scores (1. Physical functioning; 2. Role limitations due to physical health; 3. Role limitations due to emotional problems; 4. Energy/fatigue; 5. Emotional wellbeing; 6. Social functioning; 7. Bodily pain; and 8. General health) were assessed before and after ablation. All health concept scores improved significantly after successful catheter ablation procedure. The result for the whole group were as follows: 1. physical functioning improved from mean 61.42±24.82 to 77.15±18.80 (p<0.001). 2. Score for the role limitations due to physical health improved from 41.78±39.17 to 75.35±33.91 (p<0.001). 3. Score for the role limitations due to emotional problems improved from 48.07±42.32 to 80.46±33.81 (p<0.001). 4. Energy/Fatigue score improved from 56.71±19.97 to 68.78±16.40 (p<0.001). 5. Emotional wellbeing score improved from 58.22±17.31 to 71.88±14.33 (p<0.001). 6. Social functioning score improved from 68.39±24.51 to 81.00±19.12 (p<0.001). 7. Pain score improved from 59.82±28.65 to 80.57±20.58 (p<0.001) and 8. General health score improved from 48.42±15.26 to 62.57±15.43 (p<0.001). This study shows that catheter ablation which can effectively cure the patients from the paroxysmal supraventricular tachycardia significantly improves physical, emotional and social health scores by eliminating the arrhythmia episodes and associated symptoms and anxiety in patients with paroxysmal supraventricular tachycardia irrespective of patient demographics and the type of the SVT.

INFLUENCE OF CATHETER ABLATION OF PAROXYSMAL SUPRAVENTRICULAR TACHYCARDIA ON PATIENTS' ANXIETY.

The aim of the study was to investigate the influence of catheter ablation of paroxysmal supraventricular tachycardia on patients' anxiety levels. We investigated 70 consecutive patients with paroxysmal supraventricular tachycardia (AV Nodal Reentrant Tachycardia (AVNRT), AV Reentrant Tachycardia (AVRT) or Atrial Tachycardia (AT)) who underwent a catheter ablation. The patients filled out the State and Trait Anxiety Inventory (STAI) before the ablation on the day of the procedure and after 3 months of a successful catheter ablation. State and trait anxiety scores were compared before and after 3 months of ablation. The results were analyzed between different age (<50 vs ≥50 y), gender and the type of paroxysmal supraventricular tachycardia (AVNRT vs AVRT/AT). Both state and trait anxiety scores improved significantly after catheter ablation. State anxiety score improved from mean 42.21±9.53 to 31.43±8.02 (p<0.001). Trait anxiety score improved from mean 45.76±7.80 to 39.80±7.33 (p<0.001). Present study demonstrates that the radiofrequency catheter ablation of paroxysmal supraventricular tachycardia by providing cure and eliminating the arrhythmia episodes significantly reduces both situational and general anxiety levels.

Depression, anxiety, and quality of life after catheter ablation in patients with paroxysmal atrial fibrillation.

BACKGROUND: Patients with paroxysmal atrial fibrillation (AF) experience impaired quality of life (QoL) and psychological distress. Catheter ablation of AF can markedly improve QoL. However, the effect of catheter ablation of AF on psychological status is unknown. HYPOTHESIS: Depression, anxiety, and QoL improve after catheter ablation in patients with paroxysmal AF. METHODS: A total of 166 consecutive patients with symptomatic paroxysmal AF were examined. Eighty-two patients (55 men, mean age 55.9 ± 6.1 y) underwent catheter ablation and 84 patients (58 men, mean age 57.2 ± 5.4 years) received antiarrhythmic drug (AAD) therapy. The Self-Rating Depression Scale, Self-Rating Anxiety Scale, and Medical Outcomes Survey 36-item Short-Form questionnaires were completed by these patients at baseline, and at 3, 6, 9, and 12 months of follow-up. Results in the ablation group were compared with those of the AAD group. RESULTS: In the ablation group, 42.7% of patients showed symptoms of depression and 37.8% showed symptoms of anxiety, which were similar to those in the AAD group. Both groups similarly displayed reduced physical and mental QoL. Catheter ablation was effective in reducing symptoms of depression and anxiety and improving QoL, and it was superior to AAD therapy (all P < 0.001). Multiple regression analysis demonstrated that catheter ablation, no AF recurrence, avoidance of warfarin use, higher baseline depression and anxiety scores, and lower baseline QoL scores contributed to improvement of depression, anxiety, and QoL, respectively. CONCLUSIONS: Catheter ablation is more effective for improving depression, anxiety, and QoL in patients with paroxysmal AF compared with AAD therapy.

Impact of radiofrequency ablation on health-related quality of life in patients with paroxysmal supraventricular tachycardia compared with a norm population one year after treatment.

OBJECTIVE: This study evaluated the impact of radiofrequency ablation (RFA) on health-related quality of life (HRQOL) in patients with paroxysmal supraventricular tachycardia (PSVT). METHODS: HRQOL was assessed with the Short Form-36 Health Survey (SF-36) and EuroQol (EQ)-5D at baseline and 3 and 12 months after RFA. At 12 months, the patients were compared with an age- and gender-matched reference group. RESULTS: Patients showed a marked improvement in all the SF-36's scales at 3 months after treatment compared with baseline. Patients scored higher in all scales in the SF-36 but not in the EQ-5D's index at 12 months compared with baseline. No further improvements were detected from 3 to 12 months follow-up. Twelve months after treatment, patients scored equal to the reference group in the SF-36 and EQ-5D index, indicating a complete restoration of the HRQOL after RFA. CONCLUSION: PSVT is a condition with a pronounced impact on HRQOL. At 12 months follow-up after RFA, patients' HRQOL scores were similar to those of the age- and gender-matched reference group.

[Liaison psychiatry in a general hospital: seven paradigmatic cases]. / Psiquiatria de ligação em hospital geral: sete casos paradigmáticos.

Through the use of case reports, this article reviews frequent causes that origin the need for psychiatric intervention in patients hospitalized in medical and surgical wards. Particular diagnosis aspects are focused, so is the necessity of integration of the biological, psychological and social dimensions of the patient. The integrated approach by the various members of the medical staff is also emphasised. The cases presented were observed in the Liaison Psychiatry Consult of the Psychiatry Service of Hospital Santa Maria, in Lisbon, between November 2007 and January 2008. Seven cases were selected because they reflect paradigms in the intervention of the Liaison Psychiatrist, and reflect the following psychiatric diagnosis: Panic Disorder; Paranoid Schizophrenia; Bipolar Disorder; Personality Disorder; Major Depression, Dementia and Abstinence Syndrome.

[Alprazolam use improves psychological status and reduces hospitalization costs in patients with paroxysmal supraventricular tachycardia underwent radiofrequency catheter ablation].

OBJECTIVE: To evaluate the effect of alprazolam use on psychological status and hospitalization cost in patient with paroxysmal supraventricular tachycardia underwent electrophysiology studies or radiofrequency catheter ablation. METHODS: In this prospective, randomized, double-blind, placebo-controlled study, 142 inpatients [77 males, mean age (43.1 +/- 14.5) years] were randomly assigned to receive alprazolam (0.4 mg qd at 10PM for 3 days, n = 72) or placebo (n = 70) 3 days before scheduled electrophysiology studies or radiofrequency catheter ablation. All patients were examined by the Chinese version of Symptom Checklist-90 (SCL-90) at 24 hours before the procedure. RESULTS: Compared with the placebo group, the scores of somatization (1.38 +/- 0.40 vs. 1.65 +/- 0.56, P < 0.01), anxiety (1.50 +/- 0.39 vs. 1.69 +/- 0.50, P < 0.05), phobic anxiety (1.24 +/- 0.36 vs. 1.47 +/- 0.57, P < 0.01), psychotism constructs (1.24 +/- 0.34 vs. 1.35 +/- 0.30, P < 0.05) and global severity index (1.36 +/- 0.35 vs. 1.49 +/- 0.37, P < 0.05) were significantly decreased in alprazolam group. The hospitalization costs were also significantly lower in alprazolam group (32 498 +/- 1170) yuan compared to placebo group (32 947 +/- 1096) yuan, P < 0.05. CONCLUSION: The alprazolam use before electrophysiology studies and radiofrequency catheter ablation can improve the patients' psychological status and reduce the hospitalization costs.

Paroxysmal atrial fibrillation, quality of life and neuroticism.

BACKGROUND: Paroxysmal atrial fibrillation (AF) is associated with significant impairment of quality of life (QoL), which is to a large extent independent of objective measures of disease severity. We sought to investigate the potential role of neuroticism in the impairment of QoL in patients with paroxysmal AF. METHODS: The study group (AF group) comprised 73 patients with paroxysmal AF (mean age 55.5 +/- 113.3 years, 50 males). On average, patients had a three-year history of one symptomatic paroxysm a week lasting two hours. QoL was assessed using the Medical Outcomes Study Short Form (SF-36) and neuroticism was assessed using the short-scale Eysenck Personality Questionnaire (EPQ). RESULTS: The degree of neuroticism in the AF patient group did not differ from the degree of neuroticism in a group of age- and sex-matched controls (mean EPQ score on neuroticism 4.1 +/- 3.0 and 3.9 +/- 3.1, respectively; p = NS). Within the AF group, multivariate regression analyses showed that QoL in the physical domain (SF-36 physical functioning, physical role function, vitality and pain subscales) was not related the degree of neuroticism. In contrast, significant inverse relations were observed between scores on the mental health and social functioning subscales and the degree of neuroticism (beta coefficients p < .05), independent of age, sex and symptoms. CONCLUSION: Based on the present study, patients with paroxysmal AF appear to have on average a degree of neuroticism similar to age- and sex-matched controls. However, the impairment of QoL in these patients, in particular regarding social functioning and mental health, seems to be related to a relatively high degree of neuroticism, independent of age and sex.

[Improvement of mental health and the quality of life after catheter ablation for paroxysmal supraventricular tachycardia].

PURPOSE: The aims of this study were to observe change in subjective symptoms, quality of life (QOL) and mental health condition after catheter ablation (CA) for paroxysmal supraventricular tachycardia (PSVT) and to assess patient evaluation of the treatment. METHODS: The questionnaire was sent to 103 patients (86 with the Wolff-Parkinson-White (WPW) syndrome and 27 with atriovetricular nodal reentrant tachycardia (AVNRT)), who had received CA from February 1995 to January 1999. The question encompassed the condition of the patient, his or her evaluation of CA treatment, and a self-rating depression scale (SDS) together with social and subjective as well as non-specific physical points. We scored for improvement of QOL and SDS. Finally, from 82 patients who participated complete responses to the questionnaire were received from 59 (72.0%). The patients (50.5 +/- 15.8 years old, WPW syndrome; 41, AVNRT; 18) almost all (98.3%) RESULTS: gave a positive evaluation of CA. Over half (54.2%) no longer needed hospital consultation for any reason while three-quarters (76.3%) were free of life limitations. The complete cure rate from physicians was 100%. However, subjective symptoms of arrhythmia attack remained in 20.3% of the cases. Social and physical QOL were significantly improved after CA (social: < 0.05, physical: < 0.01) and the SDS score decreased significantly (< 0.05). 1. Self-awareness frequency of tachycardia attack, frequency of going to hospital and life CONCLUSION: limitations of PSVT patients decreased after CA. 2. QOL (social and physical QOL) and mental health condition significantly improved after CA. 3. Almost all patients (98.3%) gave a positive evaluation of CA. 4. Healthcare professionals should be aware that not only drug therapy, but also CA is effective for improvement of mental health and the QOL of patients with PSVT.

The influences of psychosocial aspects and anxiety symptoms on quality of life of patients with arrhythmia: investigation in paroxysmal atrial fibrillation.

The purpose of this study was to investigate the feature of the psychosocial aspects of patients with atrial fibrillation and to explore the influences of the subjective symptoms of attack, perceived psychosocial inducers of attack, and anxiety on the quality of life (QOL). The participants were 240 patients with paroxysmal atrial fibrillation (57.89 +/- 13.78 years old), who were requested to complete questionnaires on the subjective symptoms of attack, perceived psychosocial inducers of attack, anxiety symptoms, and QOL. The results of this study showed that 29.5% patients met the criteria of agoraphobia of Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association, 1994). This percentage of prevalence was higher than the general prevalence of DSM-IV data. The subjective symptoms of attack (frequency, duration, and distress of attack) intensify their fear of attack and agoraphobic symptoms, which worsen their QOL. Psychological stress is the main perceived inducer in daily life, and a attack induced by psychological stress affects their anxiety symptoms and QOL.

Neuropsychological deficits in asymptomatic atrial fibrillation.

OBJECTIVE: To assess the preclinical effects on cognitive functions of nonrheumatic atrial fibrillation (NRAF) in patients with negative history for cerebrovascular disease. MATERIALS AND METHODS: The study included 37 consecutive patients with chronic (n=16, mean age 65.3+/-6.6 years) or paroxysmal (n=21, mean age 58.3+/-9.5 years) NRAF and an equal number of control subjects in sinus rhythm, who were matched for age, education and presence of hypertension. A comprehensive neuropsychological battery including tests of attention, memory, language and visuospatial skills was administered. RESULTS: Patients with chronic NRAF showed significantly poorer performances in tasks exploring attention and verbal memory functions, while the paroxysmal group was significantly impaired in a long-term memory task. The neuropsychological findings were confirmed excluding from both groups patients with CT evidence of cerebrovascular damage. A small subgroup of patients was also submitted to cerebral MRI. CONCLUSION: Neurologically asymptomatic NRAF is related to a subclinical but significant impairment in attention and memory. These deficits could be produced by minor ischemic lesions due to microembolization, or by diffuse hypoxic damage due to hypoperfusion.

Paroxysmal atrial tachycardia recorded by Holter monitoring during an episode of fear. A case report.

A twenty-four-year-old, white, athletic woman, free of heart disease, experienced an episode of fear when she was assaulted in the street without physical injury while under-going twenty-four-hour Holter monitoring. She developed an important sympathetic response in which, besides the symptoms characterized by palpitations, chest pain, dyspnea, asthenia, dizziness, nausea, and profuse cold sweating, she had an episode of paroxysmal atrial tachycardia. The causes and mechanism of this not well-documented event in humans are discussed.