Predictors of non-pharmacological intervention in patients with paroxysmal atrial fibrillation: Value of neuroticism

Background Non-pharmacological intervention is gaining increasing popularity in the treatment of patients with paroxysmal atrial fibrillation. We sought to investigate which factors play a role in the choice for non-pharmacological intervention with a particular focus on neuroticism. Methods The study group comprised 73 patients with paroxysmal atrial fibrillation (mean age 55 ± 13 years, 50 males). On average, patients had a 3-year-history of one symptomatic paroxysm per week lasting 2 h. The degree of neuroticism was assessed using the short scale Eysenck Personality Questionnaire. Results During a mean follow-up period of 7.0 ± 0.6 years, 20 patients (27%) underwent a non-pharmacological intervention for atrial fibrillation including His bundle ablation (n = 1), maze operation (n = 4), DDDR-pacemaker (n = 10), pulmonary vein ablation (n = 5). Multivariate regression analysis showed that age < 55 years (odds ratio 5.3, 95% CI 1.1–24.5), frequency of paroxysms of atrial fibrillation > 1 per week (odds ratio 5.9, 95% CI 1.2–28.5) and total number of anti-arrhythmic drugs (class I and III) used > 2 (odds ratio 3.4, 95% CI 1.6–6.9) were predictive of non-pharmacological intervention (all p < 0.05). In contrast, the degree of neuroticism was similar in patients who underwent non-pharmacological intervention as opposed to patients who did not undergo non-pharmacological intervention (4.5 ± 3.3 vs. 4.0 ± 2.9, p = NS). Conclusions On the basis of this small study, neuroticism would not appear to play an important role in the decision to perform a non-pharmacological intervention. Instead, the data indicate that younger patients with pharmacologically refractory atrial fibrillation more often undergo non-pharmacological intervention.