App‐Based Mental Training to Reduce Atrial Fibrillation–Related Symptoms After Pulmonary Vein Isolation: MENTAL AF Trial

Abstract

Background Even after atrial fibrillation (AF) catheter ablation, many patients still experience relevant symptom burden. The objective of the MENTAL AF trial was to determine whether app‐based mental training (MT) during the 3 months following pulmonary vein isolation reduces AF‐related symptoms. Methods and Results Patients scheduled for pulmonary vein isolation were enrolled and randomized 1:1 to either app‐based MT or usual care. Of 174 patients, 76 in the MT and 75 in the usual care group were included in the final analysis. The intervention was delivered by a daily 10‐minute app‐based MT. The primary outcome was the intergroup difference of the mean AF6 sum score, an AF‐specific questionnaire, during the 3‐month study period. Secondary outcomes included quality‐of‐life measures such as the AFEQT (Atrial Fibrillation Effect on Quality of Life). Mean age (SD) was 61 (8.7) years and 61 (41%) were women. The mean AF6 sum score over the study period was 8.9 (6.9) points in the MT group and 12.5 (10.1) in the usual care group (P=0.011). This referred to a reduction in the AF6 sum score compared with baseline of 75% in MT and 52% for usual care (P<0.001). The change in the AFEQT Global Score was 22.6 (16.3) and 15.7 (22.1), respectively; P=0.026. Conclusions MENTAL AF showed that app‐based MT as an adjunctive treatment tool following pulmonary vein isolation was feasible. App‐based MT was found to be superior to standard care in reducing AF‐related symptom burden and improving health‐related quality of life. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT04067427.

Keywords

• atrial fibrillation
• disease perception
• mental training
• pulmonary vein isolation
• symptom burden