Houston, Texas, USA : Depressed people have an increased risk of atrial fibrillation (AF or AFib), according to a study published today in the European Journal of Preventive Cardiology, a European Society of Cardiology (ESC) journal. Medication was not responsible for the high frequency of atrial fibrillation in depressed people. The findings are reported during Global AF Aware Week.
Study author Morten Fenger-Grøn, senior statistician, Research Unit for General Practice, Aarhus University, Denmark, said: “It is common knowledge that there is a connection between the mind and the heart. Depression predicts the development of coronary artery disease and worsens its prognosis.2 Our study investigated whether depression is also linked with atrial fibrillation.”
Atrial fibrillation is the most common heart rhythm disorder (arrhythmia). It causes 20-30% of all strokes and increases the risk of dying prematurely.3 One in four middle-aged adults in Europe and the US will develop atrial fibrillation. It is estimated that by 2030 there will be 14-17 million patients with atrial fibrillation in the European Union, with 120,000-215,000 new diagnoses each year. Signs of atrial fibrillation include palpitations, shortness of breath, tiredness, chest pain and dizziness.4
Previous studies have found associations between depression and both more severe symptoms and higher mortality in atrial fibrillation patients.5 Antidepressants have been linked with some serious, but rare, heart rhythm disturbances, prompting the question of whether they might also raise the risk of atrial fibrillation.
This study investigated the association of depression, and antidepressant treatment, with the risk of developing atrial fibrillation. Filling a prescription for antidepressants for the first time was used as an indicator of depression.
The study included all 785,254 Danish citizens initiating antidepressant treatment from 2000 to 2013 and a 1:5 random sample of the Danish population matched on sex and birth month. The risk of atrial fibrillation was assessed after starting treatment and in the month before, when it was assumed that patients were depressed but medically untreated.
Compared with the general population, patients taking antidepressants had a 3.18-fold higher risk of atrial fibrillation during the first month of treatment. The association gradually reduced thereafter, to 1.37-fold at 2-6 months, and 1.11-fold at 6-12 months.
Mr Fenger-Grøn said: “Filling a prescription for antidepressants, which we used as an indicator of depression, was associated with a three-fold greater risk of atrial fibrillation. The decrease with time could suggest that treatment may alleviate this risk.”
The risk of atrial fibrillation risk was even higher in the month before starting antidepressants (7.65-fold). “This suggests that antidepressant medication itself is not associated with the development of atrial fibrillation,” said Mr Fenger-Grøn. “If you are depressed, there is no reason to worry that taking drug treatment will cause atrial fibrillation.”
Mr Fenger-Grøn noted that in the month before starting medication, the risk of atrial fibrillation was 7.65-fold from 30 to 15 days before, and 4.29-fold in the last 15 days before. He said: “In Denmark it is not typical for doctors to prescribe antidepressants at the first appointment. Our findings indicate that the initial conversation with a doctor may start to ease depressive symptoms.”
He added: “The message for patients who already have atrial fibrillation is that you do not need to be concerned about taking antidepressant medication if you need it. Look after your mental health because our study supports existing evidence that problems with the mind can be detrimental for the heart.”
What is Atrial Fibrillation? (AFib)
Atrial fibrillation (AFib) is the most common type of arrhythmia (abnormal heart rate or rhythm). During AFib, the heart’s upper chambers (atria) beat in an irregular pattern (fibrillate).
Normally, the electrical signals that control the heartbeat begin in an area of the right atrium called the sinoatrial node. The signals travel from the atria to the heart’s lower chambers (ventricles). This electrical pattern causes the heart’s chambers to contract in a coordinated rhythm that pumps blood from the atria to the ventricles.
In AFib, the electrical signals originate in other parts of the atria or in the pulmonary veins, which bring blood from the lungs into the right atrium. The signals spread through the atria in a disorganized way, causing fibrillation.
As these erratic electrical signals spread through the heart, the ventricles also begin to beat rapidly, but out of sync with the atria. As a result, the atria cannot properly pump blood to the ventricles, which in turn cannot pump enough blood to the body.
Atrial fibrillation prevents your heart from pumping blood normally. It increases your risk of stroke and can lead to heart failure.
Symptoms Of Atrial Fibrillation
You may not notice any symptoms at first. Symptoms may occur only occasionally or constantly, depending on the type of AFib you have. Common symptoms include:
- Chest pain or discomfort
- Difficulty exercising because you tire easily
- Fatigue or low energy
- Heart palpitations (feeling that your heart is beating too hard or too fast, fluttering, or skipping a beat)
- Lightheadedness, dizziness, or fainting (syncope)
- Shortness of breath\
Causes Of Atrial Fibrillation
In some people with AFib, the cause is unknown. This condition is known as lone AFib. Usually, AFib results from damage to the heart’s electrical system from other health conditions, such as:
- Blockage of a lung artery (pulmonary embolism)
- Congenital heart disease (heart birth defects)
- Heart conditions, including a heart attack, heart failure, cardiomyopathy, coronary artery disease, or valvular heart disease
- Heart surgery, such as bypass surgery
- Inflammation of the membrane that surrounds the heart (pericarditis)
- Stress from pneumonia or other infections
- Thyroid problems, especially an overactive thyroid (hyperthyroidism)
- Use of some medications, including certain decongestants and diet pills
- Use of stimulants such as caffeine, tobacco, excessive alcohol use, and some illegal drugs
These factors may increase your risk of AFib:
- Chronic health conditions such as chronic lung or kidney disease, diabetes, high blood pressure, or sleep apnea
- Family medical history
- Increased age
Types of Atrial Fibrillation (AFib)
There are three types of AFib, determined by how frequently they occur. The symptoms and causes of all three types are the same. AFib may occur more frequently over time and can become permanent.
Paroxysmal Atrial Fibrillation
This type of AFib occurs occasionally, starting and stopping on its own. Paroxysmal AFib can last for just a few seconds or minutes, or it can last hours or days before your heart returns to its normal rhythm. As the AFib comes and goes, your pulse rate may go from slow to fast and back to slow in a short time.
Persistent Atrial Fibrillation
This AFib continues for more than a week. It may resolve on its own, or it may require treatment.
Permanent Atrial Fibrillation
The permanent type does not go away, either by itself or with treatment. Medications and other treatments can control your symptoms and manage the condition. These treatments can help maintain a regular heart rate and rhythm or thin your blood to help prevent stroke.
No matter what type of AFib you have, the arrhythmia experts at Stanford can help. Our doctors participate in groundbreaking research to develop improved therapies for AFib and other types of arrhythmias.
Aadvanced treatments for AFib include:
- Several types of cardiac ablation
- Implantable cardioverter-defibrillator (ICD)
- MAZE procedure
Diagnostic Tests for Atrial Fibrillation (AFib)
Diagnostic Tests for Atrial Fibrillation by an arrhythmia team starts with a comprehensive diagnostic evaluation, taking extra time and care to thoroughly understand your symptoms. reputation for our deep Advanced diagnostic testing for atrial fibrillation includes:
- Blood tests: We check for levels of thyroid hormone, electrolytes, and other substances that can cause AFib.
- Chest X-ray: This imaging study uses radiation to produce images of your heart.
- Echocardiogram (echo): This test uses sound waves (ultrasound) to create detailed images of your heart. The type used most often is a transthoracic echocardiogram (TTE), which captures the images from several locations on your chest.
- Electrocardiogram (EKG): This painless, noninvasive test uses a monitor with electrodes attached to your body to measure your heart’s electrical activity.
- Holter and event monitors: These portable EKG monitors record your heart’s electrical activity over a longer time. Holter monitors record your heart continuously for 24 to 48 hours. Event monitors record abnormal activity only when it occurs, over several weeks.
- Stress test: This test measures your heart’s electrical activity using an EKG while you exercise on a treadmill or stationary bicycle.
- Transesophageal echocardiogram (TEE): This type of echocardiogram (echo, or heart ultrasound) is an imaging test that uses sound waves to produce images of the heart’s structures. A TEE involves an ultrasound probe inserted into the mouth and down the esophagus to provide more detailed images than an external echo.