1. Koleck, Theresa A. PhD
  2. Mitha, Shazia MPhil
  3. Biviano, Angelo MD
  4. Caceres, Billy A. PhD
  5. Corwin, Elizabeth J. PhD
  6. Goldenthal, Isaac MS
  7. Creber, Ruth Masterson PhD
  8. Turchioe, Megan Reading PhD
  9. Hickey, Kathleen T. EdD
  10. Bakken, Suzanne PhD

Article Content

We thank Ms Brown1 for her Letter to the Editor entitled "Mental Health of Cardiac Procedure Patients Should Be a Priority for All Healthcare Providers," which was motivated by our study that explored depressive symptoms and anxiety among patients with atrial fibrillation and/or flutter at the time of cardioversion or ablation.2 Our descriptive analysis was part of the iHEART randomized controlled trial.3 We are pleased that our findings resonated with Ms Brown's clinical experience in the electrophysiology laboratory and that the findings stimulated her to read further on the topic and implement change in her practice.


In her Letter to the Editor, Ms Brown cited a review by Fitzgerald et al4 that highlighted the influence of lifestyle modification on recurrence of atrial fibrillation after cardiac ablation. Ms Brown also noted the potential relevance of smartphone platforms as a mechanism for intervention delivery. In fact, the importance of lifestyle modification in decreasing recurrence of atrial fibrillation motivated our team's development of the iHEART intervention, a smartphone intervention comprising recording of heart rhythm via the AliveCor KardiaMobile device and text messages designed to modify lifestyle risk factors.3,5-7


We agree with Ms Brown's assertion about the importance of mental health as a healthcare provider priority for patients undergoing cardiac procedures including cardioversion and ablation. In particular, we would like to underscore the links between postablation lifestyle modifications, mental health, and outcomes such as recurrence that Ms Brown raises. Regular physical activity, for example, reduces the odds of recurrence and improves quality of life postablation, but anxiety among postablation patients has been linked to reticence to engage in physical activity.8,9 Furthermore, we argue that attention to mental health should occur throughout the clinical and self-management of atrial fibrillation. In a recent cohort study of patients with incident atrial fibrillation (n = 239 222), the prevalence of any mental health condition (eg, depression, anxiety disorder, bipolar disorder, schizophrenia) was 19.9%.10 Notably, the authors found that those with mental health conditions were less likely than those without mental conditions to receive antiarrhythmic therapy including cardioversion, ablation, and drug treatment. Consequently, we urge implementation of strategies to promote health equity in treatment for patients experiencing atrial fibrillation.




1. Brown C. Mental health of cardiac procedure patients should be a priority for all healthcare providers. J Cardiovasc Nurs. 2023;38(2):117. [Context Link]


2. Koleck TA, Mitha SA, Biviano A, et al. Exploring depressive symptoms and anxiety among patients with atrial fibrillation and/or flutter at the time of cardioversion or ablation. J Cardiovasc Nurs. 2021;36(5):470-481. [Context Link]


3. Hickey KT, Hauser NR, Valente LE, et al. A single-center randomized, controlled trial investigating the efficacy of a mHealth ECG technology intervention to improve the detection of atrial fibrillation: the iHEART study protocol. BMC Cardiovasc Disord. 2016;16:152. [Context Link]


4. Fitzgerald JL, Middeldorp ME, Gallagher C, Sanders P. Lifestyle modification and atrial fibrillation: critical care for successful ablation. J Clin Med. 2022;11(9):2660. [Context Link]


5. Goldenthal IL, Sciacca RR, Riga T, et al. Recurrent atrial fibrillation/flutter detection after ablation or cardioversion using the AliveCor KardiaMobile device: iHEART results. J Cardiovasc Electrophysiol. 2019;30(11):2220-2228. [Context Link]


6. Lee J, Turchioe MR, Creber RM, Biviano A, Hickey K, Bakken S. Phenotypes of engagement with mobile health technology for heart rhythm monitoring. JAMIA Open. 2021;4(2):ooab043. [Context Link]


7. Masterson Creber RM, Reading Turchioe M, Biviano A, et al. Cardiac symptom burden and arrhythmia recurrence drives digital health use: results from the iHEART randomized controlled trial. Eur J Cardiovasc Nurs. 2022;21(2):107-115. [Context Link]


8. Proietti R, Birnie D, Ziegler PD, Wells GA, Verma A. Postablation atrial fibrillation burden and patient activity level: insights from the DISCERN AF study. J Am Heart Assoc. 2018;7(23):e010256. [Context Link]


9. Sarnholm J, Skuladottir H, Ruck C, et al. Internet-delivered exposure-based therapy for symptom preoccupation in atrial fibrillation: uncontrolled pilot trial. JMIR Cardio. 2021;5(1):e24524. [Context Link]


10. Teppo K, Jaakkola J, Biancari F, et al. Mental health conditions and bleeding events in patients with incident atrial fibrillation: a Finnish nationwide cohort study. Gen Hosp Psychiatry. 2022;78:117-122. [Context Link]