Reduced Prevalence of Mental Health Disorders in Arrhythmia Patients and patient presenting for Catheter Ablation

Introduction
Mental health disorders (MHD) have been increasingly recognized for their significant impact on cardiovascular diseases. However, data on the relationship between mental health and arrhythmias are scarce and inconclusive. Some studies suggest that patients with supraventricular tachyarrhythmias exhibit higher levels of demoralization rather than clinically significant depressive symptoms.

Objective
To examine the prevalence of MHD among patients with cardiovascular diseases, focusing on patients with diverse cardiac arrhythmias.

Methods
We conducted a retrospective analysis of 8,189 patients treated at the Department of Cardiology between 2018 and 2023. Documented diagnoses and medication lists were reviewed to identify specific mental health diagnoses, arrhythmias. Initially, a large language model was employed to extract relevant keywords associated with the specific diagnoses. These keywords were then manually verified for accuracy and compiled into a comprehensive dictionary. This dictionary was used by a Python-based keyword-finding algorithm to recognize different diagnoses within the patient records, with the code designed to tolerate spelling mistakes through the use of flexible matching techniques.

Results
The cohort had an average age of 69.5 ± 14.6 years, with 55.4% females. Among these patients, 4,467 (54.5%) had arrhythmias, while 3,722 (45.5%) did not. Notably, out of the patients with arrhythmias, 2,389 received catheter ablation. Patients with arrhythmias were older than those without (71.3 ± 12.7 vs. 67.3 ± 16.2 years; p < 0.001). The average BMI was similar between groups (arrhythmias: 27.8 ± 8.6; no arrhythmias: 27.5 ± 6.4; p = 0.489). The arrhythmia group had a higher proportion of females (58.5% vs. 48.3%; p < 0.001).

Significantly fewer patients with arrhythmias had documented MHD compared to those without arrhythmias (487 vs. 714; p < 0.001). Antidepressant use was lower in patients with arrhythmias (202 vs. 313; χ² = 51.40; p < 0.001). Antipsychotic use was also lower in patients with arrhythmias (52 vs. 90; χ² = 18.01; p < 0.001).

In a subgroup analysis, patients with arrhythmias who underwent catheter ablation had fewer documented MHD compared to those who did not (168 vs. 319; p < 0.001). Antidepressant use was lower in ablated patients (70 vs. 132; p < 0.001), as was antipsychotic use (10 vs. 42; p < 0.001). Among patients with documented MHD, antipsychotic use was significantly lower in ablated patients (5.95% vs. 13.17%; OR = 0.42; p = 0.0136).

Conclusion 
Our study found that cardiovascular patients with arrhythmias had a lower prevalence of MHD and were less likely to be on psychopharmacological treatment compared to those without arrhythmias. Among patients with arrhythmias, those who underwent catheter ablation exhibited significantly fewer MHD and required less psychiatric treatment. While the lower prevalence of arrhythmias among patients with MHD might suggest that effective treatment reduces arrhythmia burden, it is also possible that arrhythmias are underdiagnosed in this population due to overlapping symptoms or less frequent cardiovascular assessments. Notably, arrhythmia patients with MHD who received ablation were less likely to be prescribed antipsychotics. These findings underscore the potential impact of comprehensive arrhythmia management on mental health outcomes, suggesting a bidirectional relationship that warrants further investigation.