A Systematic Review of Depression and Anxiety in Patients with Atrial Fibrillation: The Mind-Heart Link

Table 4

Summarizes studies presented in “The Benefit of AF Treatment on Depression and Anxiety and Impact of Depression and Anxiety on Treatment Success” section.

	Subjects	Follow-up period	Measure of anxiety, depression	Intervention	Results
Rate and/or rhythm control
Frasure-Smith et al. [31]	933 patients with AF and CHF	39 ± 18 months	ASI, BDI	Electrical Cardioversion; AAD	Higher ASI showed better long-term prognosis with rhythm than rate control (𝑃=0.022)
Lange and Herrmann-Lingen [32]	54 patients with persistent AF	2 months	HADS, DS-14	Electrical cardioversion	(i) An HADS depression score >7 was associated with AF recurrence (85% depressed patients versus 39% nondepressed patients; 𝑃=0.004).; (ii) HADS anxiety score or type D personality was associated with AF recurrence
Catheter ablation
Fichtner et al. [33]	133 patients with paroxysmal and persistent AF	4.3 ± 0.5 years	MDI	PVI ± linear or electrogram-guided substrate modification for AF	(i) Regardless of AF type or ablation success, pts. experienced a significant reduction in depressive symptoms (𝑃<0.001); (ii) However, successful ablation led to greater reduction in depressive symptoms than unsuccessful ablation (𝑃=0.039)
Wokhlu et al. [34]	502 patients with paroxysmal, persistent, and longstanding AF	3.1 years	MAFS; SF-36	PVI ± linear or electrogram-guided substrate modification for AF	(i) AF ablation produces sustained QoL improvement at 2 years regardless of ablation efficacy; (ii) Symptom relief, baseline QoL status, and potential for discontinuing warfarin were found to improve QoL
Sang et al. [35]	166 patients with paroxysmal AF	12 months	SDS, SAS, and SF-36	Catheter ablation; AAD	(i) In patients with paroxysmal AF, catheter ablation improves anxiety, depression, and QoL PCS and MCS scores (𝑃<0.001, 𝑃=0.001, 𝑃<0.001, and 𝑃=0.006, resp.) and is superior to AAD therapy in all measures (𝑃<0.001); (ii) Catheter ablation, no AF recurrence, avoidance of warfarin use, higher baseline depression, anxiety scores, and lower baseline QoL scores were associated with reduction in depression and anxiety and improvement in QoL, respectively
Mohanty et al. [36]	660 patients with paroxysmal AF, persistent AF, and long standing persistent AF	12 months	BDI, HAD, STAI, and SF-36	Catheter ablation	(i) Successful ablation was associated with greater reduction in HAD anxiety, HAD depression, and BDI and greater improvement in SF-36 PCS scores (𝑃=0.003; 𝑃<0.001; 𝑃=0.024; 𝑃<0.001, resp.); (ii) STAI scores did not show any association with ablation success
Yu et al. [37]	146 patients with persistent AF	12 months	SAS, SDS	CVPA; AAD	(i) Anxiety and depression improved after successful ablation (𝑃<0.01 for both); (ii) There was no change in anxiety or depression scores in the AAD from baseline to 12 months after enrollment; (iii) SAS and SDS scores ≥ were independent risk factors of AF recurrence one-year status after CPVA (𝑃=0.02 for both)
Complementary and alternative medicine
Lakkireddy et al. [38]	49 patients with paroxysmal AF	3-month control (patients are own control) 3-month yoga therapy	SAS, SDS, and SF-36	Iyengar yoga instruction for 60 min at least 2 times weekly	(i) In patients with paroxysmal AF, yoga reduced the number of symptomatic AF episodes, symptomatic non-AF episodes, and asymptomatic AF episodes (𝑃<0.001 for all).; (ii) Yoga improved anxiety and depression scores (𝑃<0.001) and QoL parameters of physical functioning, general health, vitality, social functioning, and mental health (𝑃=0.017, 𝑃<0.001, 𝑃<0.001, 𝑃=0.019, and 𝑃<0.001)

SAS: Zung Self-Rating Anxiety Scale; SDS: depression symptoms Zung Self-Rating Depression Scale; SF-36: Medical Outcomes Short Form-36; BDI: Becks Depression Inventory; HAD: Hospital Anxiety and Depression scale; MDI: major depression inventory; MAFSI: Mayo AF-Specific Symptom Inventory; STAI: State Trait Anxiety Inventory; Qol: quality of life.