A bidirectional relationship between atrial fibrillation and depression: epidemiology, mechanisms, and clinical implications

Atrial fibrillation (AF) represents a common cardiac arrhythmia that carries substantial morbidity and mortality risks, whereas depression serves as a significant psychological factor affecting cardiovascular health. Recent findings underscore a reciprocal relationship between AF and depression, suggesting that depression may heighten the likelihood of developing AF, while AF may, in turn, worsen depressive symptoms. This review aims to provide a thorough examination of the epidemiological features that underpin this relationship, focusing on population-based research that clarifies prevalence rates and associated risk factors. Furthermore, it delves into the intricate biological and psychosocial mechanisms that connect these two conditions, which include dysregulation of the autonomic nervous system, inflammation, neurohormonal pathways, and behavioral influences. The clinical ramifications of this reciprocal association are also addressed, highlighting the necessity for integrated screening and management approaches to enhance patient outcomes. By consolidating existing research, this article seeks to enrich the understanding of the relationship between AF and depression, as well as to assist clinicians in optimizing therapeutic strategies tailored to address this dual burden.