JMIR Publications

ABSTRACT

Background:

Atrial fibrillation (AF) is the most common cardiac arrhythmia, affecting 3% of the population. AF is associated with poor quality of life (QoL) and, in many patients, AF symptoms (e.g., palpitations) are not alleviated by current medical treatments. Patients often present with symptom preoccupation in terms of symptom fear, avoidance and control behaviors. Internet-delivered cognitive behavior therapy (internet-CBT) is effective for other somatic disorders, but has never been evaluated in patients with AF.

Objective:

The aim of this study was to evaluate the efficacy and feasibility of AF-specific internet-CBT.

Methods:

We conducted an uncontrolled pilot study where 19 patients with symptomatic paroxysmal AF underwent internet-CBT. Participants completed self-assessments at pre-treatment, post-treatment and at six-month follow-up, along with handheld ECG measurements with symptom registration. The treatment lasted 10 weeks and included exposure to physical sensations, exposure to avoided situations and behavioral activation.

Results:

We observed large within-group improvements in the primary outcome, AF-specific QoL (Cohen’s d=0.80; P<. 001), and in symptom preoccupation (Cohen’s d=1.24; P<. 001) at post-treatment; the results were maintained at six-month follow-up. Treatment satisfaction and adherence were high. We observed an increased AF burden, measured by ECG, at six-month follow-up but a significant decrease in overestimation of AF symptoms at post-treatment and six-month follow-up. Exploratory mediation analysis showed that reduction in symptom preoccupation mediated the effect of internet-CBT 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-CBT. Clinical Trial: ClinicalTrials.gov: NCT02694276.