216-76: Cognitive Behavioral Therapy improves symptoms and quality of life in paroxysmal atrial fibrillation

Purpose: Symptomatic paroxysmal atrial fibrillation (AF) is associated with poor quality of life (QoL) but the correlation between AF-burden and symptomatic burden is weak. AF-related anxiety and avoidance of physical and social activities may cause symptom preoccupation and contributes to impaired QoL. Cognitive behavioral therapy (CBT), based on exposure and behavioral activation, reduces symptom severity and depression/anxiety in other somatic disorders. This pilot-study aimed to develop and evaluate a disease-specific CBT for paroxysmal AF.

Methods: We studied 19 patients with symptomatic paroxysmal AF, despite optimal medical therapy. Patients with an LVEF ≤35% or a significant vitium were excluded. CBT consisted of 10 weekly meetings with a psychologist and included the following: patient education, exposure to physical activity (e.g. jogging on the spot, running up a flight of stairs), sensations that are similar to AF symptoms (e.g. palpitations due to physical activity or stress), and behavioral activation aiming to increase physical and social functioning. Primary outcome was AF-specific QoL measured by the Atrial Fibrillation Effect on QualiTy-of-life (AFEQT) questionnaire before and after CBT.

Results: [1] After CBT, QoL was markedly improved (Cohen's d = 1.61; p < .001) and 12 of 19 patients (63%) reported clinical significant improvement on the AFEQT. Furthermore, large effects were observed on cardiac symptom frequency (d = 1.12; p < .001), symptom severity (d = 1.24, p < .001), social functioning (d = 1.26, p = .001), general worry (d = 0.90, p = .002), and general health (d = 0.83, p = .001). We also observed moderate improvements in depressive symptoms (d = 0.71; p = .02) and physical functioning (d = 0.69; p = .02). We are currently collecting 6-month follow-up data.

Conclusion: This study presents preliminary evidence for the effectiveness of a novel interdisciplinary CBT approach in the treatment of paroxysmal AF, that has the potential to improve QoL in a large group of patients.