Abstract
BackgroundAtrial fibrillation (AF) is the most common cardiac arrhythmia in the adult population. AF is associated with a poor quality of life (QoL) and, in many patients, current medical treatments are inadequate in alleviating AF symptoms (eg, palpitations). Patients often present with symptom preoccupation in terms of symptom fear, avoidance, and control behaviors. Internet-delivered cognitive behavior therapy is effective for treating other somatic disorders but has never been evaluated in patients with AF.ObjectiveThe aim of this study is to evaluate the efficacy and feasibility of AF-specific internet-delivered cognitive behavior therapy.MethodsWe conducted an uncontrolled pilot study in which 19 patients with symptomatic paroxysmal AF underwent internet-delivered cognitive behavior therapy. Participants completed self-assessments at pretreatment, posttreatment, and at a 6-month follow-up along with handheld electrocardiogram measurements with symptom registration. The treatment lasted 10 weeks and included exposure to physical sensations, reduction in avoidance behavior, and behavioral activation.ResultsWe observed large within-group improvements in the primary outcome, AF-specific QoL (Cohen d=0.80; P<.001), and in symptom preoccupation (Cohen d=1.24; P<.001) at posttreatment; the results were maintained at the 6-month follow-up. Treatment satisfaction and adherence rates were also high. We observed an increased AF burden, measured by electrocardiogram, at the 6-month follow-up, but a significant decrease was observed in the overestimation of AF symptoms at posttreatment and 6-month follow-up. Exploratory mediation analysis showed that a reduction in symptom preoccupation mediated the effects of internet-delivered cognitive behavior therapy on AF-specific QoL.ConclusionsThis study presents preliminary evidence for the potential efficacy and feasibility of a novel approach in treating patients with symptomatic AF with internet-delivered cognitive behavior therapy.Trial RegistrationClinicalTrials.gov NCT02694276; https://clinicaltrials.gov/ct2/show/NCT02694276
Highlights
Atrial fibrillation (AF) is the most common cardiac arrhythmia, with a prevalence of approximately 3% in the general adult population [1]
During the analysis of the ECG data that were obtained after inclusion, we discovered that two participants had persistent AF at the pretreatment assessment, which means that they, in retrospect, did not fulfill the inclusion criteria of paroxysmal AF at the pretreatment assessment; both the participants and their treating physician had reported paroxysmal AF during the inclusion process and were assessed by the research team as such
The sample had disproportionately more women and the subjects were younger than the general AF population [50], further limiting the generalizability of the results. Another limitation is that the handheld ECG is not a continuous measurement of the cardiac rhythm, which may contribute to undetected AF symptoms remaining undetected. This is the first study in which patients with symptomatic paroxysmal AF were treated with therapist-guided exposure-based internet-Cognitive behavior therapy (CBT)
Summary
Atrial fibrillation (AF) is the most common cardiac arrhythmia, with a prevalence of approximately 3% in the general adult population [1]. Current treatment strategies (pharmacological and invasive therapies) are associated with potentially serious side effects and do not sufficiently reduce the symptom burden in many patients with AF [4,5]. AF is associated with a poor quality of life (QoL) and, in many patients, current medical treatments are inadequate in alleviating AF symptoms (eg, palpitations). Internet-delivered cognitive behavior therapy is effective for treating other somatic disorders but has never been evaluated in patients with AF. Objective: The aim of this study is to evaluate the efficacy and feasibility of AF-specific internet-delivered cognitive behavior therapy. Exploratory mediation analysis showed that a reduction in symptom preoccupation mediated the effects of internet-delivered cognitive behavior therapy on AF-specific QoL. Conclusions: This study presents preliminary evidence for the potential efficacy and feasibility of a novel approach in treating patients with symptomatic AF with internet-delivered cognitive behavior therapy.
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