Panic features strongly predict the subjective but not the objective benefit of pulmonary vein isolation



Clinically observed discrepancies between electrocardiogram findings and subjective report of symptoms related to atrial fibrillation (AF) often remain unexplained. One could hypothesize that after a technically successful ablation, preoperative panic behavior might affect the report of AF-related symptoms. However, research on comorbid panic behavior in patients with AF is limited.


In this observational prospective cohort study, we investigated psychological characteristics, in particular the prevalence of panic features, among 112 patients with AF and its possible influence on experienced outcome of subsequent ablation treatment.


Twelve percent of the AF patients (n = 12) were pre-operatively characterized by panic features. This group experienced higher levels of distress and more limitations in daily life compared to AF patients without panic features, but was not characterized by higher levels of neuroticism. However, AF-ablation resulted in a similar reduction of experienced limitations in daily functioning and levels of distress in both groups.


Patients with panic features experience more distress and more limitations in daily life from AF, but these complaints are reduced by AF ablation in a similar rate as in patients without panic features. Additional psychological therapy is suggested as a method to further reduce subjective AF disease burden in these patients.

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  1. 1.

    Patel D, McConkey ND, Sohany R, McNeil A, Jedrzejczyk A, Armaganijan L. A systematic review of depression and anxiety in patients with atrial fibrillation: the mind-heart link. Cardiovasc Psychiatry Neurol. 2013;2013(1):159850.

    Article  Google Scholar 

  2. 2.

    Mohanty S, Di Biase L, Bai R, Santangeli P, Pump A, Horton R, et al. A quality of life and patient-centered outcomes following atrial fibrillation ablation: short- and long-term perspectives to improve care. Exp Rev Cardiovasc Ther. 2012;10:889–900.

    CAS  Article  Google Scholar 

  3. 3.

    Walfridsson H, Walfridsson U, Nielsen JC, Johannessen A, Raatikainen P, Janzon M, et al. Radiofrequency ablation as initial therapy in paroxysmal atrial fibrillation: results on health-related quality of life and symptom burden. The MANTRA-PAF trial. Europace. 2015;17:215–21.

    CAS  Article  Google Scholar 

  4. 4.

    Thompson TS, Barksdale DJ, Sears SF, Mounsey JP, Pursell I, Gehi AK. The effect of anxiety and depression on symptoms attributed to atrial fibrillation. Pace. 2014;37:439–46.

    Article  Google Scholar 

  5. 5.

    Abrignani MG, Renda N, Abrignani V, Raffa A, Novo S, Lo Baido R. Panic disorder, anxiety and cardiovascular diseases. Clin Neuropsychiatry. 2014;11:130–44.

    Google Scholar 

  6. 6.

    Lioni L, Vlachos K, Letsas K, Efremidis M, Karlis D, Asvestas D, et al. Differences in quality of life, anxiety and depression in patients with paroxysmal atrial fibrillation and common forms of atrioventricular reentry supraventricular tachycardias. Indian Pacing Electrophysiol J. 2004;14:250–7.

    Article  Google Scholar 

  7. 7.

    Frommeyer G, Eckhardt L, Breithardt G. Panic attacks and supraventricular tachycardias: the chicken or the egg? Neth Heart J. 2013;21:74–7.

    CAS  Article  Google Scholar 

  8. 8.

    Sears SF, Serber ER, Alvarez LG, Schwartzman DS, Hoyt RH, Ujhelyi MR. Understanding atrial symptom reports: objective versus subjective predictors. Pace. 2005;18:801–7.

    Article  Google Scholar 

  9. 9.

    Cheng YF, Leu HB, Su CC, Huang CC, Chiang CH, Huang PH, et al. Association between panic disorder and risk of atrial fibrillation: a nationwide study. Psychosom Med. 2013;75:30–5.

    Article  Google Scholar 

  10. 10.

    Yu S, Zhao Q, Wu P, Qin M, Huang H, Cui H. Effect of anxiety and depression on the recurrence of parxysmal atrial fibrillation after circumferential pulmonary vein ablation. J Cardiovasc Electrophysiol. 2012;23:17–23.

    Article  Google Scholar 

  11. 11.

    Efremidis M, Letsas KP, Lioni L, Giannopoulos G, Korantzopoulos P, Vlachos K, et al. Association of quality of life, anxiety and depression with left atrial ablation outcomes. Pace. 2014;37:703–11.

    Article  Google Scholar 

  12. 12.

    Walfridsson U, Arestedt K, Stromberg A. Development and validation of a new arrhytmia-specific questionnaire in tachycardia and arrhytmia (ASTA) with focus on symptom burdon. Health Qual Life Outcomes. 2012;10:1–10.

    Article  Google Scholar 

  13. 13.

    Denissen JJA, Geenen R, Van Aken MAG, Gosling SD, Potter J. Development and validation of a Dutch translation of the big five inventory (BFI). J Pers Assess. 2008;90(2):152–7.

    Article  Google Scholar 

  14. 14.

    Eifert GH, Thompson RN, Zvolensky MJ, Edwards K, Haddad J, Frazer NL, et al. The cardiac anxiety questionnaire: development and preliminary validity. Behaviour Res Ther. 2000;38:1039–53.

    CAS  Article  Google Scholar 

  15. 15.

    Chambless DL, Caputo GC, Bright P, Gallagher R. Assessment of fear of fear in agoraphobics : the body sensations questionnaire and the agoraphobic cognitions questionnaire. J Consult Clin Psychol. 1984;52(6):1090–7.

    CAS  Article  Google Scholar 

  16. 16.

    Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67:361–70.

    CAS  Article  Google Scholar 

  17. 17.

    Kuyumcu MS, Ozeke O, Cay S, Ozcan F, Bayraktar MF, Kara M, et al. The short-term impact of the catheter ablation on noninvasive autonomic nervous system parameters in patients with paroxysmal atrial fibrillation. Pacing Clin Elctrophysiol. 2017;40:1193–9.

    Article  Google Scholar 

  18. 18.

    Van den Berg MP, Ranchor AV, Van Sonderen F, van Gelder IC, Van Veldhuisen D. Paroxysmal atrial fibrillation, quality of life and neuroticism. Neth J Med. 2005;63:170–4.

    PubMed  Google Scholar 

  19. 19.

    Garimella RS, Chung EH, Mounsey JP, Schwartz JD, Pursell I, Gehi AK. Accuracy of patient perception of their prevailing rhythm: a comparative analysis of monitor data and questionnaire responses in patients with atrial fibrillation. Hearth Rhythm. 2015;12:658–65.

    Article  Google Scholar 

  20. 20.

    Camm AJ, Kirchhof P, Lip GYH, Schotten U, Savelieva I, Ernst S, et al. Guidelines for the management of atrial fibrillation. The task force for the management of atrial fibrillaton of the European Society of Cardiology. Eur Heart J. 2010;31:2369–429.

    Article  Google Scholar 

  21. 21.

    Nationaal Kompas Volksgezondheid. Angststoornissen. 12 August 2016, Date last Accessed.

  22. 22.

    Olazabal Eizaguirre N, Chavez R, Gonzalez-Torres MA, Gaviria M. Trastorno de panico y fibrilacion auricular. Semergen. 2013;39:370–5.

    CAS  Article  Google Scholar 

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Correspondence to Jürgen C. P. J. Knobel.

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Knobel, J.C.P.J., Van der Werf, S.P., Van den Berg, F.F. et al. Panic features strongly predict the subjective but not the objective benefit of pulmonary vein isolation. J Interv Card Electrophysiol 56, 191–197 (2019).

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  • Panic
  • Atrial fibrillation
  • Ablation
  • Outcome