Emotional distress in patients before first-time and redo catheter ablation for atrial fibrillation

Background: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and is frequently accompanied by anxiety and depressive symptoms, which may negatively affect quality of life and treatment outcomes. While catheter ablation (CA) is an established therapy for AF, data comparing emotional distress burden prior to first-time vs redo CA procedures remain limited. Aim: To compare pre-procedural levels of anxiety and depression in patients undergoing first-time AF/atypical atrial flutter CA vs those undergoing redo AF/atypical atrial flutter CA. Methods: This prospective observational study included consecutive patients with AF or atypical atrial flutter scheduled for CA (first-time or redo) between January 2024 and May 2025. Anxiety and depressive symptoms were assessed one day prior to the CA using the Hospital Anxiety and Depression Scale (HADS). Results: Overall, 112 patients who underwent first-time CA and 49 patients who underwent redo CA were included in the study. Baseline demographic characteristics were comparable between groups. Patients scheduled for first-time (vs redo) CA demonstrated significantly higher emotional distress burden. Median HADS depression and anxiety scores were significantly higher in the first-time CA group compared with the redo CA group (10 [9–11] vs. 2 [1–5], p < 0.001 and 13 [11,5-14] vs 5 [2-9], p<0.001; respectively). Conclusions: Patients facing their first-time AF CA experience significantly higher levels of anxiety and depressive symptoms than those undergoing redo CA. These findings suggest that procedural familiarity may reduce emotional distress.