Cognitive-behavioral therapy (CBT) may deserve to be positioned alongside ablation and rhythm and rhythm control drugs as a management option for some patients. paroxysmal atrial fibrillation (AF), new research suggests.
A module-based CBT intervention. Conducted online on a small scale. randomized trialwhich appears to reduce cardiac-related anxiety and psychological distress in patients with a history of such reactions to perceived atrial fibrillation symptoms.
A 10-week training program that included exposure therapy aimed at reversing symptom-related fears and other stressful behaviors improved quality of life (QoL) scores compared with standard AF patient education programs. and reduced use of medical resources. .
The study highlights the contribution of symptom preoccupation, including anxiety avoidance behaviors to perceived atrial fibrillation triggers, to the overall disability from paroxysmal atrial fibrillation, the researchers say. The report notes its preoccupation with AF symptoms as “an important target for treatment” and supports internet-based CBT as a “feasible and clinically effective” intervention, the report said. there is Issued on June 26 in the Journal of the American College of Cardiology.
Dr. Josephine Sarnholm, lead author at the Karolinska Institutet in Stockholm, Sweden, says that available treatments for symptomatic paroxysmal atrial fibrillation rarely relieve all symptoms. heart.org | Medscape Cardiology. “Many of my patients expect to be symptom-free after ablation.” she pointed out.
“We know that anxiety and hyper-vigilance in constantly waiting for the next atrial fibrillation bout to occur increases awareness of the severity of symptoms,” Sarnholm said. In such cases, a CBT intervention “may be a very valuable add-on treatment.”
Benefits Unrelated to Atrial Fibrillation Burden
In this study, 127 patients with paroxysmal atrial fibrillation (all of whom had “atrial fibrillation symptoms that they experienced that interfered with or limited their daily activities”) were placed in either groups following an online CBT program, or They were randomly assigned to groups (65 and 62, respectively) who received standard atrial fibrillation patient education.All were on optimal medication and scheduled for next catheter ablation or recently underwent treatment.
The group following the 10-week CBT program was shown to be 15 points better than the standard care group in summary scores on the Atrial Fibrillation Impact on Quality of Life (AFEQT) questionnaire (P. < .001) at 3 months, and the effect persisted at 12 months of follow-up. It also showed a 56% reduction in heart-related medical visits compared to the control group (P. = .027).
However, there was no significant difference between the two groups in the AF load measured over 5 consecutive days. electro-cardiogram Monitoring was performed at baseline and after 3 months. There were also no differences across the studies in terms of medication use, particularly antidepressants, anxiolytics, beta-blockers, and other medications that might affect stress responses or the effectiveness of CBT, Sarnholm said. Stated.
The results of a randomized trial of this kind are “the first known” and “show promise in treating patients preoccupied with symptoms of atrial fibrillation,” said Mayo Clinic APRN, Rochester, Minnesota. – CNS Dr. Pamela J. McCabe writes:of Accompanying editorial.
“Improving QoL and reducing cardiac anxiety, depressiondisorders, symptoms,” she said, suggesting that CBT in trials with exposure therapy “could be another tool for symptom management” in such patients.
It is noteworthy that CBT improved QoL despite no difference in AF burden between the two groups, the editorial continues. “This finding should further strengthen our awareness of the idea that QoL improvement and symptomatic distress relief do not depend on reduction of objective atrial fibrillation burden.”
The current study is “impressive and important,” said Dr. Samuel F. Sears Jr. heart.org | Medscape Cardiology. He strongly agreed that CBT training with such exposure therapy deserves consideration as a routine adjunct to catheter ablation for patients with symptomatic AF.
Dr. Sears, a cardiology specialist at East Carolina University in Greenville, N.C., who was not involved in this report, has led research on anxiety and QoL associated with implantable cardioverter-defibrillator shock. has played a role.
A secondary finding that CBT reduces atrial fibrillation-related checkups seems encouraging for the strategy’s potential in the United States, he said. But “hospital administrators and others who want to invest in this type of treatment must be cost-saving or at least cost-neutral,” Sears said. “You’ll have to prove or show that the benefits will save you money.”
moreover, Small clinical group U.S. medical institutions have the expertise to perform such interventions for patients with atrial fibrillation, he said. It means that “the training of interdisciplinary psychologists and cardiologists is not sufficient.”
6 modules and homework
CBT interventions “emphasize systematic and repetitive exposure to cardiac-related symptoms and avoided situations, and reduce excessive symptom-control behaviors such as repeated pulse checks,” the report said. ing.
It features six educational and interactive modules, where patients receive virtual guidance online from a team of specially trained psychologists, answer questions, and complete “homework” assignments via email. can be reviewed. Sarnholm said patients will receive “personalized feedback” two to three times a week. “We made sure it was very relevant for each individual.”
Yet, on average, online therapists spent only about 6 minutes per week with each patient. “This is a fairly inexpensive add-on treatment that we are trying to introduce into everyday practice in Sweden.”
Zahnholm made no disclosures. Potential conflicts with other authors are noted in the report. McCabe did not report any related relationships. Sears has published the following consulting: Medtronic, Abbott, Milestone Pharmaceuticals, and Sol Medical. We receive honoraria from Medtronic, Biotronik, and Zoll Medical.
J. am col cardiole. Published online on June 26, 2023. overview, editorial
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