Stress has been associated with poor health outcomes, although the exact mechanism remains unclear. Psychological stress is recognized as a contributing factor to atrial fibrillation (AFib), both in the initiation and the increase of AFib. The diagnosis of atrial fibrillation is often associated with increased anxiety, psychological distress, and suicidal ideation. In a review article published today in JACC: Clinical Electrophysiologypotential mechanisms linking stress and atrial fibrillation and the possible use of stress reduction in the management of atrial fibrillation are explored.
Atrial fibrillation is an irregular and often rapid heartbeat that can cause blood clots to form in the heart. People diagnosed with atrial fibrillation are at increased risk of stroke, heart failure, and other heart complications. AFib is the most common arrhythmia in the world. There is significant overall variation in the number of people reporting psychological stress, but on average it is felt by 1 in 3 people. The authors define stress “as the perception of internal or external demands that exceed the ability to adaptive response”. Reported stress levels are increasing every year with the COVID-19 pandemic, leading to an even greater increase in self-reported psychological distress.
We find that psychological stress and even negative emotions are associated with AFib initiation and potentiation. Recognizing stress as a potentially modifiable risk factor in these patients supports a more holistic approach to the management of atrial fibrillation. As such, targeted stress reduction may improve symptom perception and outcomes for patients with atrial fibrillation. »
Peter Kistler, MBBS, PhD, Slead author of the study, Head of Clinical Electrophysiology Research at the Baker Heart and Diabetes Institute and Head of Electrophysiology at Alfred Hospital Melbourne, Australia
The researchers reviewed studies on the role of stress in atrial fibrillation, as well as on modifying traditional risk factors for atrial fibrillation such as diet, stopping alcohol and exercise. The review also focuses on the bidirectional nature of the relationship between atrial fibrillation and stress. The study authors examined the role of acute and chronic stress in the induction of AFib; the role that stress plays in the physiological modification of the heart; gender differences in response to stress; as well as how to measure stress, which is often subjective and self-reported.
“We also need to take better account of the bidirectional nature of stress and atrial fibrillation. More and more studies are showing that it works both ways,” Kistler said. “Stress breeds atrial fibrillation and atrial fibrillation breeds stress. When we manage patients with atrial fibrillation, clinicians tend to focus on the physical symptoms of atrial fibrillation and not fully consider the consequences on basic and progressive sanity of a heart rhythm disorder.”
According to the study, stress and negative emotions are often accompanied by modifiable risk factors. For example, people with chronic stress often report higher numbers of smoking, drinking, weight gain, and physical inactivity. Risk factors contribute to aggravation of symptoms of atrial fibrillation in patients. Potential treatment options for reducing stress in the management of atrial fibrillation included further investigation of anxiolytic and antidepressant therapy, mindfulness-based stress reduction, and yoga.
“Clinicians must recognize and address the psychosocial implications of an atrial fibrillation diagnosis by providing patient education and reassurance in tandem with conventional interventions to reduce symptoms and improve quality of life,” Kistler said. “By considering the impact of stress on illness perception, recognizing and mitigating stress can reduce symptoms and distress, improve resilience, and modify health behaviors to improve outcomes.”
The authors conclude that further research is needed to establish standardized methods for detecting and quantifying stress, while randomized trials are needed to better assess the impact of stress reduction on the management of atrial fibrillation.
American College of Cardiology