Effekte der Vorhofflimmerablation auf psychosoziale Aspekte sowie Lebensqualität bei Patient*innen mit paroxysmalem/persistierendem Vorhofflimmern
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Abstract
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and, due to its high incidence, progressive nature, and associated cardiovascular risks, represents a major challenge in contemporary cardiology. Beyond well-established somatic complications such as stroke, heart failure, and hospitalizations, the psychosocial consequences of AF have increasingly come into focus. Numerous studies demonstrate that AF not only produces physical symptoms but also substantially impairs patients’ quality of life. Symptoms such as palpitations, reduced performance capacity, and sleep disturbances frequently co-occur with anxiety, depressive mood, and heart-related insecurity, often leading to social withdrawal or avoidance behavior.
AF therefore affects the entire biopsychosocial functioning of affected individuals.
The aim of the present study was to systematically investigate the effects of pulmonary vein isolation (PVI) on psychosocial parameters and health-related quality of life, thereby addressing an existing gap in the literature. While the rhythmological efficacy of catheter ablation is well established, evidence regarding the extent to which psychosocial factors benefit—directly or indirectly—from the intervention remains limited, particularly in the early postprocedural phase. The prospective, single-center study conducted at Klinikum Fulda included approximately 125 patients with paroxysmal or persistent AF undergoing their first PVI procedure, performed using either radiofrequency ablation with an Ablation Index algorithm or pulsed-field ablation. Psychosocial assessment employed validated instruments capturing various dimensions of emotional and functional health: the Short Form-12 Health Survey, the Hospital Anxiety and Depression Scale, the Heart Anxiety Questionnaire, and the Pain Disability Index. Measurements were obtained at baseline and three months postablation.
The results demonstrated a consistent pattern of significant improvements across all psychosocial domains. Both physical and mental quality of life increased, anxiety and depressive symptoms declined, heart-related fears were reduced, and functional impairment scores improved markedly. These effects were evident not only in the overall cohort but also across nearly all examined subgroups, regardless of age, sex, AF type, or overweight status. Notably, psychosocial improvements were also
observed in patients who continued to report recurrent arrhythmic episodes. This suggests that reductions in arrhythmia burden, perceived therapeutic control, and associated autonomic or emotional responses may contribute to early psychosocial recovery, even in the absence of complete rhythm stabilization.
The findings align with results from major international rhythm-control studies, which have shown that PVI contributes to sustained improvements in quality of life, emotional burden, and psychological stability beyond its electrophysiological effects. Evidence from placebo-controlled trials further indicates that these benefits are not solely attributable to expectation or subjective attribution, but may reflect genuine biological and psychological mechanisms of action.
In summary, the present work underscores the importance of psychosocial endpoints in the management of patients with AF. The results demonstrate that successful rhythm intervention should not be defined solely by the absence of arrhythmia but also by its holistic impact on physical functioning, emotional stability, and daily life integration. Incorporating psychosocial parameters complements purely rhythmological evaluation and enables a more comprehensive, patient-oriented assessment of therapeutic success.
This study therefore provides an important scientific basis for integrating psychosocial diagnostics into routine cardiological ablation programs. It shows that PVI is not only an interventional electrophysiological procedure but a therapeutic approach with measurable effects on psychological well-being and overall life functioning. The findings support further incorporation of psychosocial considerations into clinical guidelines, follow-up strategies, and individualized treatment decisions, thereby advancing a more holistic understanding of rhythmology.
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This item has been published with the following license: In Copyright