P3833An independent risk of atrial fibrillation recurrences rate after catheter ablation in paroxysmal atrial fibrillation patients: infection associated with phychological distress - One center experi

Abstract

Background: There is evidence that depression is related to reduced natural killer cell cytotoxicity (NKCC) and enhanced cytokine production in healthy individuals. Depression is common in paroxysmal atrial fibrillation (AF) patients (pts) and worsens while the recurrences becoming more frequent. Their combined effect on AF recurrences rate after catheter ablation in patients with paroxysmal atrial fibrillation is unknown. Aim: We examined the role of hostility, depression, somatic symptom, anxiety, overall phychological distress and associated infectious illness on long-term AF recurrences in pts with paroxysmal non-valvular AF underwent catheter ablation with Pulmonary Vein Isolation. (PV- ablation) Methods: The study included 85 pts with non-valvular paroxysmal AF (52men), mean age 52±16 years, after cardioversion for the first documented recurrent episode of AF, followed successful first time catheter ablation by complete PV isolation, prospectively with annual Kellner Symptom phychometric questionnaire at 20 weeks interviews. Blood was drawn after the randomization, at each interview and during each AF recurrence episode. NKCC was measured by 3-hour chromium release assay. We calculated the incidence rate of AF by quartiles of phychometric scores using logistic Generalized Estimating Equation. We estimated the odds ratio (ORs) and 95% confidence intervals (CI), to represent the association between depression, anxiety, somatic symptom, and hostility scores and risk of AF. Results: After adjusting for non phychological risk factors, of AF, such as age, sex, lasting of paroxysmal AF before Catheter Ablation and the partial ablation technique differences, the higher anxiety, depression hostility somatic symptom and total phychological distress were significantly associated with risk recurrences of AF. Compared with the lowest quartile group, being in a higher quartile group was associated with a significant increase in risk. For each higher quartile group, adjusted odds ratio for total phychological distress was 2. 9 (CI, 1.4-4.8). Compared to those without phychological distress, depressed pts had diminished NKCC (26.1±12 vs 12.4±9.6% [50:1effector to target ratio], p=0.02). Conclusions: Among patients with recurrences after catheter ablation for paroxysmal AF, phychological distress in general is associated with reduced NKCC, increased infectious illness and with a dose-response increase in the long-term risk of AF recurrence rate, independent of other risk factors of recurrences. Considered cognitive behavioral therapy may add promise for reducing AF recurrences in this population by depression management.