The effect of anxiety and depression on symptoms attributed to atrial fibrillation

Pacing Clin Electrophysiol. 2014 Apr;37(4):439-46. doi: 10.1111/pace.12292. Epub 2013 Nov 11.


Background: Symptoms attributed to atrial fibrillation (AF) are nonspecific, and it remains unclear what influences perception of symptoms. Anxiety or depression may be important in modulating perception of AF symptoms. However, few longitudinal studies have addressed this effect.

Methods: A total of 378 patients with AF completed anxiety and depression severity questionnaires as well as AF symptom and frequency severity questionnaires. Patients were offered treatment strategies including catheter ablation or antiarrhythmic or rate-controlling medications. Patients were followed at 3-month intervals and completed follow-up questionnaires including repeat assessment of anxiety, depression, and AF symptoms. A method of generalized estimating equations was used for longitudinal analyses.

Results: Analysis revealed that increased anxiety or depression was associated with increased AF symptom severity (AFSS), after adjusting for potential confounders. In both unadjusted and adjusted follow-up analyses, antiarrhythmic drug therapy or catheter ablation reduced AFSS (P < 0.001). However, none of anxiety severity, depression severity, or the perception of AF frequency severity improved significantly with AF treatment.

Conclusions: Our results extend previous studies demonstrating that anxiety and depression are associated with worsened AFSS. Antiarrhythmic drug therapy or catheter ablation reduces AFSS but does not affect depression and anxiety symptoms. To achieve more comprehensive AF symptom relief, treatment of both AF and psychological comorbidities may be beneficial.

Keywords: anxiety; atrial fibrillation; depression; quality of life.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Distribution
  • Anti-Arrhythmia Agents / therapeutic use
  • Anxiety / epidemiology*
  • Anxiety / psychology*
  • Atrial Fibrillation / epidemiology*
  • Atrial Fibrillation / psychology*
  • Atrial Fibrillation / therapy*
  • Catheter Ablation / psychology
  • Catheter Ablation / statistics & numerical data
  • Causality
  • Comorbidity
  • Depression / epidemiology*
  • Depression / psychology*
  • Female
  • Humans
  • Incidence
  • Longitudinal Studies
  • Male
  • Middle Aged
  • North Carolina / epidemiology
  • Risk Factors
  • Sex Distribution
  • Treatment Outcome


  • Anti-Arrhythmia Agents