Cognitive Behavioral Therapy for Paroxysmal Atrial Fibrillation: Heart Rate Variability, Physical Activity, and Sleep.

Background: Cognitive behavioral therapy for symptom preoccupation in paroxysmal atrial fibrillation (AF-CBT) significantly improved AF-specific quality of life in a recent trial. To what extent this may this may be associated with changes in physiological parameters is yet to be determined.
Objectives: The purpose of this study was to assess the effects of AF-CBT on heart rate variability (HRV), physical activity, and sleep.
Methods: Patients with symptomatic paroxysmal AF on optimal medical therapy (mean ± standard deviation 65.4 ± 8.3 years, 58% females, 61% on beta-blockers) were randomized to a 10-week online AF-CBT (n = 65) or AF education (n = 62). AF-CBT was therapist-led and focused on social and physical avoidance. A 5-day Patch-Holter with an integrated accelerometer was applied at baseline, post-treatment, and at 3-month follow-up to assess AF burden, HRV, physical activity, and sleep duration. Subjective assessments were made by the International Physical Activity (IPAQ) and Insomnia Severity Index questionnaires.
Results: At baseline, participants walked on average 8040 ± 2600 steps/day and slept 8.0 ± 1.1 hours. Objective and subjective physical activity and sleep duration remained unchanged after treatment, with no significant difference between the groups. The Insomnia Severity Index score went from subclinical insomnia (12.2 ± 6.7) to near normal values (8.1 ± 5.6), a significant change compared to controls ( P  = 0.032). No changes were found in AF burden or HRV indices at rest during the day or at night.
Conclusions: In this select cohort, AF-CBT decreased insomnia severity but had no impact on HRV or physical activity. Thus, AF-CBT may operate through psychological and behavioral factors that are not targeted by current medical and lifestyle interventions.
Competing Interests: This study was supported by grants from the Swedish Research Council (2016-013792016-01379); Region Stockholm; the ALF project (20160260), Stockholm, Sweden; Mats Kleberg’s Foundation (2015-00088), Stockholm, Sweden; and Karolinska University Hospital, Stockholm, Sweden. None of the funding bodies had any influence on the study design, implementation, data analysis, or interpretation. Dr Skúladóttir has received lecture fees from Novo Nordisk and AstraZeneca. Dr Ljótsson has authored a self-help book based on exposure-based cognitive behavior therapy for health anxiety that is available in the public marketplace. Dr Arnardóttir has received honoraria from Nox Medical, ResMed, Jazz Pharmaceuticals, Linde Healthcare, Wink Sleep, Apnimed, and Vistor, as well as being a member of the Philips Sleep Medicine and Innovation Medical Advisory Board. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
(© 2024 The Authors.)