During an episode of atrial fibrillation, the patient will be conscious of chest tightness, palpitations and other manifestations, and sometimes tension and anxiety will arise. The author has also encountered some patients with paroxysmal atrial fibrillation who have been emotionally tense, sometimes with a normal heart rhythm, but also with palpitations and chest tightness, when the blood pressure is usually normal and the heart rate is fast, and the patient will feel better after being reassured. So what exactly is the relationship between atrial fibrillation and anxiety?
Possible mechanisms of atrial fibrillation with depression and anxiety.
1, Symptoms such as chest tightness and palpitations during atrial fibrillation can cause anxiety.
2. Lack of awareness of atrial fibrillation in patients may equate atrial fibrillation with sudden cardiac death, thus causing panic.
3, anxiety about the complications of atrial fibrillation (embolism, heart failure, etc.).
4, Atrial fibrillation can lead to autonomic remodeling, and autonomic nerves have a regulatory effect on emotions.
5, Increased acetylcholinesterase activity in dogs with atrial fibrillation in animal models, and vagal denervation in the atrial muscle.
6, Increased sympathetic nerve activity and increased sympathetic nerves in atrial muscle in patients with atrial fibrillation and animal models.
Effects of anxiety on atrial fibrillation.
1, Anxiety and depression can adversely affect atrial fibrillation by affecting autonomic activity, inflammation of the body and endothelial functional responses.
2, Friedman et al. in the United States pointed out the presence of autonomic nervous system dysfunction during anxiety, which is manifested by a decrease in vagal tone and heart rate variability (HRV).
3, anxiety makes people’s sympathetic nervous system hyperfunction, and the concentration of adrenaline in the blood increases.
4. The more severe the anxiety, the more pronounced the activation of sympathetic nerves.
5. Sympathetic nerves can shorten the atrial expiration period and can cause alternating action potential intervals, and adrenergic nerve excitation can induce atrial ectopic excitation, which can trigger folding and induce atrial fibrillation.
In addition, it has also been shown that the incidence of anxiety and depression is higher in patients with atrial fibrillation than in the healthy population, and that anxiety can increase the recurrence rate after radiofrequency ablation for atrial fibrillation.
What to do when atrial fibrillation is combined with anxiety
Anxiety may be secondary to the discomfort of atrial fibrillation, and aggressive conversion of the atrial fibrillation rhythm to sinus rhythm can have a favorable outcome. This also suggests that aggressive resuscitation therapy (e.g., radiofrequency ablation) may be more advantageous than heart rate control for patients with indications.
And the treatment of anxiety, including.
1, cognitive-behavioral therapy: that is, patiently explaining the condition to the patient and eliminating concerns.
2, medication: mainly includes anti-anxiety/depression drugs, such as Valium, Dexedrine, etc.. However, some adverse effects of these drugs may be detrimental to the heart and need to be used with caution.
When anxiety comes along with atrial fibrillation, while we as doctors actively address atrial fibrillation as the initiator, patients can also try to relax and change their focus so as not to let anxiety help atrial fibrillation and improve their quality of life.