Accepted for/Published in: JMIR Cardio
Date Submitted: Oct 20, 2023
Open Peer Review Period: Oct 19, 2023 - Dec 14, 2023
Date Accepted: Apr 9, 2024
(closed for review but you can still tweet)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Cognitive Behavioral Therapy for Symptom Preoccupation in Premature Ventricular Contractions- a pilot study
ABSTRACT
Background:
Premature ventricular contractions (PVCs) are a common cardiac condition often associated with disabling symptoms and impaired Quality of Life (QoL). Current treatment strategies have limited effectiveness in reducing symptoms and restoring QoL. Symptom preoccupation, that is cardiac-related fear, hypervigilance and avoidance behavior is associated with disability in other cardiac conditions and can be effectively targeted by cognitive behavioral therapy (CBT).
Objective:
To evaluate the effect of a PVC-specific CBT protocol targeting symptom preoccupation in patients with symptomatic idiopathic PVCs.
Methods:
Patients diagnosed with symptomatic idiopathic PVCs (n=19) underwent PVC-specific CBT over 10 weeks . The treatment was delivered by a licensed psychologist via video conference in conjunction with online text-based information and homework assignments. The main components in the treatment were exposure to cardiac-related symptoms and reducing cardiac-related avoidance and control behavior. Self-rated measures were collected at baseline, post-treatment, and at three- and six-month follow-up. Primary outcome was PVC-specific QoL at post-assessment measured with an PVC-adapted version of the Atrial Fibrillation effects on Quality of Life (AFEQT-PVC). Secondary measures included symptom preoccupation measured with the Cardiac Anxiety Questionnaire. PVC burden was evaluated with 5-day continuous electrocardiogram at baseline, post- treatment, and at six-month follow-up.
Results:
We observed large improvements in PVC-specific QoL (Cohen’s d=1.62, p<.001), and in symptom preoccupation (Cohen’s d=1.73, p<.001) post-treatment. These results were sustained at three- and six-month follow-up. PVC burden as measured with 5-day continuous electrocardiogram remained unchanged throughout follow-up. However, self-reported PVC symptoms were significantly lower at post-treatment assessment, and three, and six-month follow-up. Reduction in symptom preoccupation mediated the effect of the intervention on PVC-specific QoL in an explorative mediation analysis.
Conclusions:
This uncontrolled pilot study shows preliminary evidence for PVC-specific CBT as a potentially effective treatment approach for patients with symptomatic idiopathic PVCs. The substantial improvements in PVC-specific QoL, symptom preoccupation, and decreased self-reported PVC-related symptoms warrants further investigation in a randomized controlled trial. Clinical Trial: ClinicalTrials.gov NCT123456, https://clinicaltrials.gov
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