Depression and anxiety disorders in patients with atrial fibrillation undergoing a pulmonary vein isolation: A systematic literature review and meta-analysis.

Atrial fibrillation (AF) is globally the most prevalent arrhythmia for which pulmonary vein isolation (PVI) is an effective intervention. A high comorbidity with mental disorders, in particular depressive and anxiety disorders, is described; however, a systematic synthesis of the existing literature is missing. This systematic review and meta-analysis aim to fill in this gap and to examine the prevalence of depressive and anxiety disorders with in-depth analyses of associated factors and predictors of recurrence of AF. A systematic search in PubMed, Web of Science, Trials, Embase, PsycInfo, and the Cochrane library was conducted. Articles on depressive and anxiety disorders according to the International Classification of Diseases (ICD) or the Diagnostic and Statistical Manual of Mental Disorders (DSM) in English-language in adults with AF undergoing PVI were included. Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were followed. Prevalence rates were synthesized, and meta-analyses were conducted to calculate the pooled point prevalence of depressive and anxiety disorders applying generalized linear mixed-effects models. Subgroup analyses on the prevalence including the age, sex, AF type, comorbid cardiovascular; meta-correlations and meta-regressions were performed. Predictors of recurrence of AF were calculated using logistic regressions. Eighteen studies with a total of 9,691 observations for depressive disorders and 8,855 observations for anxiety disorders were included. The meta-analyses revealed an overall point prevalence of 20.10% [95% Confidence interval (CI): 13.31% to 29.18%] for depressive disorders and 25.18% [95% CI: 11.71% to 46.08%] for anxiety disorders in patients undergoing PVI. Subgroup analyses indicated higher prevalence rates of depressive disorders in younger patients, those with paroxysmal AF, and patients with comorbid conditions such as heart failure, diabetes, hypertension. Older patients and those with cardiovascular disorders showed a higher prevalence of anxiety disorder. The correlation between pre- and post-PVI mental health status was strong (r = .99 for depression), but neither pre-ablation depression (OR = 1.022, p = .638) nor anxiety (OR = 1.003, p = 0.830) significantly predicted AF recurrence. Meta-regression analyses did not identify significant moderators explaining existing between-study heterogeneity. Depressive and anxiety disorders are highly prevalent among patients with AF undergoing PVI, particularly with higher rates of depression in younger individuals, those with paroxysmal AF, and patients with comorbid cardiovascular conditions. While mental health status improved post-PVI, neither pre-ablation depression nor anxiety were significant predictors of AF recurrence. This suggests that mental health diagnostics and interventions should be integrated into routine care, although they may not directly impact AF recurrence after PVI. Current guidelines address the management of the psychosocial dimension and comorbid mental disorders of AF insufficiently, indicating an unmet need for structured psychosomatic co-management within an interdisciplinary, patient-centered care framework. Following a biopsychosocial approach may be beneficial and warrants further targeted investigation in AF populations.