Psychological stress is recognized as a contributing factor in atrial fibrillation (AFib), both in initiation and heightening of AFib. In a review paper published Feb. 23 in JACC: Clinical Electrophysiology, potential mechanisms linking stress and AFib and the possible use of stress reduction in AFib management are explored.

Louise Segan, MBBS, MPH, et al., examined studies on the role of stress in AFib, as well as modifying traditional AFib risk factors such as diet, alcohol cessation and exercise. They also focused on the bidirectional nature of the AFib and stress relationship; looked at the role of acute and chronic stress in inducing AFib; the role stress plays on physiologically changing the heart; gender differences in response to stress; and how to measure stress, which is often subjective and self-reported.

According to the review, stress and negative emotions are often accompanied by modifiable risk factors and individuals experiencing chronic stress often report higher numbers of smoking, alcohol consumption, weight gain and physical inactivity. The risk factors contribute to worsening AFib symptoms in patients.

“Recognizing stress as a potentially modifiable risk factor in these patients builds on a more holistic approach to AFib management,” explains Peter Kistler, MBBS, PhD, senior study author. “As such, targeted stress reduction may improve symptom perception and outcomes for patients with AFib.”

The authors note that potential treatment options to reduce stress as part of AFib management included further study into anxiolytic and antidepressant therapy, mindfulness-based stress reduction and yoga.

“Clinicians must recognize and address the psychosocial implications of an AFib diagnosis by providing patient education and reassurance in tandem with conventional interventions to reduce symptoms and improve quality of life,” said Kistler. “By considering the impact of stress on illness perception, recognizing and mitigating stress may reduce symptoms and distress, enhance resilience and modify health behaviors to improve outcomes.”

Moving forward, the authors conclude that further research is needed to establish standardized methods of detecting and quantifying stress, while randomized trials are needed to better evaluate the impact of stress reduction on AFib management.

Clinical Topics: Arrhythmias and Clinical EP, Cardiovascular Care Team, Prevention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Diet, Smoking, Stress

Keywords: Diet, Smoking, Emotions, Perception, Weight Gain, Antidepressive Agents, Health Behavior, Electrophysiology, Alcohol Drinking, Stress, Psychological, Risk Factors, Yoga, Sex Factors, Quality of Life, Anti-Anxiety Agents, Atrial Fibrillation

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