App-based mental training reduces AF symptoms after catheter ablation
An app-based mind and body intervention significantly reduced atrial fibrillation-related symptom burden during the 3 months after catheter ablation compared with usual care, according to findings from a randomized controlled trial.
Catheter ablation offers an effective treatment option for AF; however, AF-related symptoms and recurrences, notably within the first 3 months after ablation, are common, Julia A. Lurz, MD, a cardiac electrophysiologist at the Heart Center Leipzig at University Leipzig, said during a press conference at Heart Rhythm 2022.
“AF, as well all know, causes a variety of symptoms, and that means stress for the patient as well as limited quality of life,” Lurz said. “We have catheter ablation as an effective treatment option, yet recurrences, notably during the 3 months after ablation, are common.”
Mindfulness exercises and AF symptoms
For the single-center MENTAL AF study, Lurz and colleagues analyzed data from 183 patients with symptomatic paroxysmal and persistent AF with a compatible smartphone and internet access who were scheduled for catheter ablation. Researchers randomly assigned patients to 3 months of mental training (n = 91) using the MINDANCE app, an audio-guided multimodule program, or usual care (n = 92). The app included a 6-week relaxation module that consisted of breathing techniques, imagination and self-talk to induce relaxation and relieve physical and mental discomfort, followed by a 6-week mindfulness module that included body acceptance and sensual meditation. The mean age of patients was 61 years and 41% were women; 45% had persistent AF.
The primary endpoint was per-protocol analysis of mean monthly AF6 summary scores, a six-item questionnaire assessing AF symptoms, during the 3-month study period. AF6 scores were reported weekly online; measures included breathing difficulties at rest, breathing difficulties on exertion, limitations in daily life, feeling of discomfort, tiredness and worry/anxiety due to AF.
At 3 months, researchers found that patients assigned to the mental training app experienced a mean 29% reduction in AF-related symptom burden based on AF6 score; mean 3-month scores were 8.9 for the intervention group and 12.5 for the usual care group (P = .011).
“Compared with baseline, both groups showed lower [AF6] scores during the 3 months; however, the mental training group had significantly lower AF6 scores during months 2 and 3, which suggests that mental training effects emerge over time,” Lurz said. The difference in AF6 scores was not significant at 1 month (P = .13), but it was at 2 months and 3 months (P for both = .006), according to the researchers.
Quality of life improvements
In subgroup analysis, the benefit of mental training was consistent across subgroups, Lurz said. Assessing quality of life measures, Lurz said there was a significant improvement for intervention patients in AFEQT score, an AF-related quality of life questionnaire. Mean change in global score from baseline to 3 months was 22.6 in the mental training group and 15.7 in the usual care group (P for intergroup changes = .026).
“Both groups benefited but the improvement was significantly more pronounced in the mental training group,” Lurz said. “App-based mental training was well received by the patients, was feasible and was able to reduce AF symptoms during the 3 months after catheter ablation, with consistent effects across subgroups.”
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Lurz JA, et al. Late Breaking Clinical Trials: Randomized Clinical Trials. Presented at: Heart Rhythm 2022; April 29-May 1, 2022; San Francisco (hybrid meeting).
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