Atrial fibrillation: Not just an electric and single organ disease

Atrial fibrillation (AF) is the most frequent arrhythmia in the general population and is associated not only with significant morbidity and mortality but also adversely impacts quality of life.1,2 Patient discomfort due to arrhythmia is not just limited to arrhythmic events. Anxiety derived from fear of a new episode is frequent in patients with paroxysmal AF, in some cases becoming more limiting than the arrhythmia itself. The current therapy aiming to control AF-related symptoms is mainly based on anti-arrhythmic drugs and catheter ablation of the pulmonary veins.3 Despite the significant improvement in this field in past decades, symptom control remains unsatisfactory in a significant proportion of cases. It has been shown that psychological factors such as anxiety, depression or stress increases the recurrence rate of AF episodes after pulmonary vein ablation.4 It has recently been shown that a stressful lifestyle, such as job strain, significantly increases the risk of AF.5 Alternative therapies that are focused on the psychosocial aspects of the disease have been shown to reduce the burden of arrhythmia and improve quality of life. Lakkireddy et al. have described how a programmed yoga training reduces the burden of arrhythmia in patients with paroxysmal AF.6 Lomuscio et al. have shown a similar effect with acupuncture in persistent AF.7 A positive influence in cardiac autonomic function and a reduction of symptoms of depression and anxiety seem to justify this protective effect. Even if evidence of the relationship between anxiety, depression and AF is growing, some pieces of this puzzle are missing.