Depression and atrial fibrillation in a reciprocal liaison: a neuro-cardiac link

Abstract

Objective

To explore the reciprocal relationship of depression and atrial fibrillation (AF).

Methods

A literature search was conducted in Pub Med, Scopus, and Google Scholar using relevant terms for depression and AF and respective therapies.

Results

There is evidence that depression is involved in the aetiology and prognosis of AF. AF, independently of its type, incurs a risk of depression in 20–40% of patients. Also, depression significantly increases cumulative incidence of AF (from 1.92% to 4.44% at 10 years); 25% increased risk of new-onset AF is reported in patients with depression, reaching 32% in recurrent depression. Hence, emphasis is put on the importance of assessing depression in the evaluation of AF and vice versa. Persistent vs paroxysmal AF patients may suffer from more severe depression. Furthermore, depression can impact the effectiveness of AF treatments, including pharmacotherapy, anticoagulation, cardioversion and catheter ablation.

Conclusions

A reciprocal association of depression and AF, a neurocardiac link, has been suggested. Thus, strategies which can reduce depression may improve AF patients’ course and treatment outcomes. Also, AF has a significant impact on risk of depression and quality of life. Hence, effective antiarrhythmic therapies may alleviate patients’ depressive symptoms.

KEY POINTS

• AF, independently of its type of paroxysmal, permanent or chronic, appears to have mental besides physical consequences, including depression and anxiety

• A reciprocal influence or bidirectional association of depression and AF, a neurocardiac link, has been suggested

• AF has considerable impact on the risk of depression occurrence with 20-40% of patients with AF found to have high levels of depression

• Also, depression significantly increases 10-year cumulative incidence and risk of AF from 1.92% to 4.44% in people without depression, and the risk of new-onset AF by 25-32%

• Emphasis should be placed on the importance of assessing depression in the evaluation of AF and vice versa

• Persistent/chronic AF patients may suffer from more severe depressed mood than paroxysmal AF patients with similar symptom burden

• Depression and anxiety can impact the effectiveness of certain AF treatments, including pharmacotherapy, anticoagulation treatment, cardioversion and catheter ablation

• Thus, strategies which can reduce anxiety and depression may improve AF patients’ course and treatment outcomes

• Also, effective antiarrhythmic therapies to control AF may alleviate patients’ depressive mood

Keywords:

• Atrial fibrillation
• depression
• bipolar disorder
• antiarrhythmic drugs
• antidepressant drugs
• quality of life
• arrhythmia ablation

Acknowledgements

None

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

Data sharing is not applicable to this article as no new data were created or analysed in this study.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.