Strengths and Limitations
A strength of this study is that it is the first randomized controlled trial, to our knowledge, to explore the effectiveness of a mindfulness meditation app together with a BCI-based wearable device among patients with AF during RFCA, which adds to the evidence base in the areas of meditation and mobile health. This study was designed rigorously. We provided the same care protocol and implemented the use of wearable devices for both groups, and recorded the time, energy, and temperature of ablation to ensure comparable conditions. In addition, this study was performed in a pragmatic setting and no maximum age for participation was stated, which adds to the generalizability of our findings.This study also has some limitations. First, it was not a double-blind trial. Neither study staff nor patients were blinded to the intervention due to the nature of the study design. However, the data analysts were masked to group allocation. Additionally, meditation practice is a long-term process. Even with the help of apps and wearable devices, it takes time to master meditation techniques to reach a meditative state faster. At least one preoperative practice session could be added to the protocol for the intervention group; however, this might affect the comparability of the baseline measures. Lastly, this is a single-center study, thus limiting the generalizability of our findings.