Depressive symptoms predict recurrence of atrial fibrillation after cardioversion

OBJECTIVE: The aim of this study was to evaluate whether depressive symptoms and the type-D personality are predictive of early recurrence of atrial fibrillation (or atrial flutter; AF) after successful electrical cardioversion (CV). BACKGROUND: Depressive symptoms are associated with an adverse prognosis in patients with coronary artery disease, congestive heart failure, and ventricular arrhythmias. Anger and hostility have been shown to be predictive of development of AF. However, little is known about the effects of depression on AF. METHODS: Fifty-four patients with persistent AF completed the Hospital Anxiety and Depression Scale (HADS) and the Type D Scale (DS-14) prior to elective electrical CV. Patients with a successful CV were followed for 2 months. RESULTS: During the follow-up period, 27 patients (50%) had recurrence of the arrhythmia. Depressive mood (HADS depression scale >7) was the only significant nonsomatic predictor of recurrence, which was observed in 85% of depressed versus 39% of nondepressed patients [odds ratio=8.6; 95% confidence interval (CI)=1.7-44.0, P=.004]. HADS anxiety scores and the presence of the type-D personality pattern were not associated with recurrence of AF. On multivariate Cox regression analysis, including variables with a prevalence >10% of the total study population and a univariate discriminative effect yielding a P value of <.2, a HADS depression score >7 was found to be the only independently predictive variable of arrhythmia recurrence (hazard ratio=2.7; 95% CI=1.05-7.2; P=.046). CONCLUSIONS: Our results indicate that depressive mood is a major risk factor for recurrence of AF after electrical CV. Heightened adrenergic tone and a proinflammatory state are possible mechanisms responsible for the observed association. Identification of depression may be of value prior to the decision to perform electrical CV.