The impact of PSVT on patients’ daily life and QOL in between episodes

Background Despite the known clinical success of radio-frequency catheter ablation (RFCA) in aborting PSVT, there is a need to better understand how PSVT impacts a patient's lived experience prior to any sort of surgical intervention, not just during episodes, but more importantly, between episodes. Patients with PSVT often report a range of emotional symptoms (sxs) that interfere with daily life in between episodes, developing avoidance actions in response to PSVT. Presently, there are limited findings detailing the impact of PSVT on patients’ daily life and QOL. Purpose To assess how PSVT affects patients’ daily life and QOL, including changes in lifestyle, emotional sxs, and effect on life satisfaction. Methods A longitudinal study included patients > 18 years old with a PSVT diagnosis and no prior ablation from two countries between March-December 2019. Patients completed weekly surveys describing sxs if they experienced a PSVT episode or a QOL survey if there weren’t episodes that week. The final cohort included 247 patients, of which 198 patients completed 2,735 QOL surveys. Results In analyzing QOL survey data, 65% of PSVT patients avoided stressful situations or took steps to reduce stress, and 31% reported these changes to be extremely bothersome. Similarly, 59% decreased or eliminated caffeine intake, while 47% decreased or eliminated alcohol consumption, and 21% and 32%, respectively, found both dietary changes to be extremely bothersome. There was moderate self-reported anxiety (3.1/7), although 26% of patients reported a 7/7 anxiety score during the study. The most frequently reported emotional sxs (4/5 or 5/5 score) were frustration (47% of patients), stress (47%), and worry (47%) [Figure]. Finally, 30% of patients reported being either dissatisfied or very dissatisfied with their sleep, 22% with their capacity for work, and 17% with their daily life. Conclusion Our study provides critical evidence that the burden of PSVT extends beyond acute episodes, and can manifest in multiple facets of life such as lifestyle restriction and avoidance behavior, significant emotional distress (frustration, stress, and worry), and measurable dissatisfaction with essential life domains like sleep and capacity for work. Paradoxically, the attempts by patients to manage their condition via avoidance behaviors are often themselves a source of considerable dissatisfaction. We propose that physicians should assess how bothersome lifestyle changes (stress, diet, exercise) are to the patient and utilize standardized scales to regularly monitor for anxiety and negative emotional states. We recommend the integration of behavioral therapy and psychological support programs to help patients manage the stressors of daily life post-PSVT diagnosis, especially in the period before definitive RFCA treatment.