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Fang S, Zhang W. Heart-Brain Axis: A Narrative Review of the Interaction between Depression and Arrhythmia. Biomedicines 2024; 12:1719. [PMID: 39200183 PMCID: PMC11351688 DOI: 10.3390/biomedicines12081719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 07/20/2024] [Accepted: 07/25/2024] [Indexed: 09/02/2024] Open
Abstract
Arrhythmias and depression are recognized as diseases of the heart and brain, respectively, and both are major health threats that often co-occur with a bidirectional causal relationship. The autonomic nervous system (ANS) serves as a crucial component of the heart-brain axis (HBA) and the pathway of interoception. Cardiac activity can influence emotional states through ascending interoceptive pathways, while psychological stress can precipitate arrhythmias via the ANS. However, the HBA and interoception frameworks are often considered overly broad, and the precise mechanisms underlying the bidirectional relationship between depression and arrhythmias remain unclear. This narrative review aims to synthesize the existing literature, focusing on the pathological mechanisms of the ANS in depression and arrhythmia while integrating other potential mechanisms to detail heart-brain interactions. In the bidirectional communication between the heart and brain, we emphasize considering various internal factors such as genes, personality traits, stress, the endocrine system, inflammation, 5-hydroxytryptamine, and behavioral factors. Current research employs multidisciplinary knowledge to elucidate heart-brain relationships, and a deeper understanding of these interactions can help optimize clinical treatment strategies. From a broader perspective, this study emphasizes the importance of considering the body as a complex, interconnected system rather than treating organs in isolation. Investigating heart-brain interactions enhance our understanding of disease pathogenesis and advances medical science, ultimately improving human quality of life.
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Affiliation(s)
- Shuping Fang
- Mental Health Center of West China Hospital, Sichuan University, Chengdu 610041, China;
| | - Wei Zhang
- Mental Health Center of West China Hospital, Sichuan University, Chengdu 610041, China;
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu 610041, China
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2
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Yue X, Zhou L, Li Y, Zhao C. Multidisciplinary management strategies for atrial fibrillation. Curr Probl Cardiol 2024; 49:102514. [PMID: 38518845 DOI: 10.1016/j.cpcardiol.2024.102514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 03/13/2024] [Indexed: 03/24/2024]
Abstract
There has been a significant increase in the prevalence of atrial fibrillation (AF) over the past 30 years. Pulmonary vein isolation (PVI) is an effective treatment for AF, but research investigations have shown that AF recurrence still occurs in a significant number of patients after ablation. Heart rhythm outcomes following catheter ablation are correlated with numerous clinical factors, and researchers developed predictive models by integrating risk factors to predict the risk of recurrence of atrial fibrillation. The purpose of this article is to outline the risk scores for predicting cardiac rhythm outcomes after PVI and to discuss the modifiable factors that increase the risk of recurrence of AF, with the hope of further improving catheter ablation efficacy through preoperative identification of high-risk populations and postoperative management of modifiable risk factors.
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Affiliation(s)
- Xindi Yue
- Division of Cardiology, Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Ling Zhou
- Division of Cardiology, Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Yahui Li
- Division of Cardiology, Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Chunxia Zhao
- Division of Cardiology, Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
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3
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Ye T, Zhou Y, Yang J, Yu F, Song Z, Shi J, Wang L, Huang Z, Yang B, Wang X. P2X7 receptor inhibition prevents atrial fibrillation in rodent models of depression. Europace 2024; 26:euae022. [PMID: 38261756 PMCID: PMC10873709 DOI: 10.1093/europace/euae022] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 12/07/2023] [Indexed: 01/25/2024] Open
Abstract
AIMS Depression, the most prevalent psychiatric disorder, is associated with the occurrence and development of atrial fibrillation (AF). P2X7 receptor (P2X7R) activation participates in the development of depression, but little attention has been given to its role in AF. This study was to investigate the effects of P2X7R on AF in depression models. METHODS AND RESULTS Lipopolysaccharide (LPS) and chronic unpredictable stress (CUS) were carried out to induce depression in rodents. Behavioural assessments, atrial electrophysiological parameters, electrocardiogram (ECG) parameters, western blot, and histology were performed. Atrial fibrillation inducibility was increased in both LPS- and CUS-induced depression, along with the up-regulation of P2X7R in atria. CUS facilitated atrial fibrosis. CUS reduced heart rate variability (HRV) and increased the expression of TH and GAP43, representing autonomic dysfunction. Down-regulation of Nav1.5, Cav1.2, Kv1.5, Kv4.3, Cx40, and Cx43 in CUS indicated the abnormalities in ion channels. In addition, the expression levels of TLR4, P65, P-P65, NLRP3, ASC, caspase-1, and IL-1β were elevated in depression models. Pharmacological inhibitor (Brilliant Blue G, BBG) or genetic deficiency of P2X7R significantly mitigated depressive-like behaviours; ameliorated electrophysiological deterioration and autonomic dysfunction; improved ion channel expression and atrial fibrosis; and prevented atrial NLRP3 inflammasome activation in the pathophysiological process of AF in depression models. CONCLUSION LPS or CUS induces AF and promotes P2X7R-dependent activation of NLRP3 inflammasome, whereas pharmacological P2X7R inhibition or P2X7R genetic deficiency prevents atrial remodelling without interrupting normal atrial physiological functions. Our results point to P2X7R as an important factor in the pathology of AF in depression.
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Affiliation(s)
- Tianxin Ye
- Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, #79 Qingchun Road, Hangzhou, Zhejiang Province 310003, PR China
| | - Yunping Zhou
- Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, #79 Qingchun Road, Hangzhou, Zhejiang Province 310003, PR China
| | - Jinxiu Yang
- Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, #79 Qingchun Road, Hangzhou, Zhejiang Province 310003, PR China
| | - Fangcong Yu
- Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, #79 Qingchun Road, Hangzhou, Zhejiang Province 310003, PR China
| | - Zhuonan Song
- Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, #79 Qingchun Road, Hangzhou, Zhejiang Province 310003, PR China
| | - Jiaran Shi
- Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, #79 Qingchun Road, Hangzhou, Zhejiang Province 310003, PR China
| | - Longbo Wang
- Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, #79 Qingchun Road, Hangzhou, Zhejiang Province 310003, PR China
| | - Zhouqing Huang
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, 2 Fuxue Road, Wenzhou, Zhejiang Province 325000, PR China
| | - Bo Yang
- Department of Cardiology, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuchang District, Wuhan 430060, PR China
- Cardiovascular Research Institute, Wuhan University, 238 Jiefang Road, Wuchang District, Wuhan 430060, PR China
- Hubei Key Laboratory of Cardiology, Wuhan 430060, PR China
| | - Xingxiang Wang
- Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, #79 Qingchun Road, Hangzhou, Zhejiang Province 310003, PR China
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Zhang S, Zhang N, Liu L, Zheng W, Ma ZL, Qiao SY, Zhao YL, Wei YH, Wu G, Yu QT, Deng B, Shen L. Global epidemiology of mental disorder in atrial fibrillation between 1998-2021: A systematic review and meta-analysis. World J Psychiatry 2024; 14:179-193. [PMID: 38327890 PMCID: PMC10845231 DOI: 10.5498/wjp.v14.i1.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 11/27/2023] [Accepted: 12/20/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND As the burden of mental disorders among patients with atrial fibrillation (AF) increases, researchers are beginning to pay close attention to the risk and prevalence of these comorbidities. Although studies have independently analyzed the risk of comorbidity with depression and anxiety in patients with AF, no study has systematically focused on the global epidemiology of these two mental disorders. AIM To explore the prevalence of depression and anxiety in patients with AF. METHODS Five databases were searched from their date of establishment until January 2023. Observational studies reporting the comorbidity of AF with depression and anxiety, were included in this study. Basic information, such as the first author/ publication year, study year, study type, and prevalence of depression and anxiety, were extracted. STATA SE 15.1 was used to analyze the data. Subgroup, meta-regression, and sensitivity analyses were performed to estimate study heterogeneity. RESULTS After a thorough search, 26 studies were identified and included in this meta-analysis. The prevalence rates of depression and anxiety in adults with AF were 24.3% and 14.5%, respectively. Among adult males with AF, the prevalence was 11.7% and 8.7%, respectively, whereas in females it was 19.8% and 10.1%, respectively. In older adults with AF, the prevalence rates of depression and anxiety were 40.3% and 33.6%, respectively. The highest regional prevalence of depression and anxiety was observed in European (30.2%) and North American (19.8%) patients with AF. CONCLUSION In this study, we found that the prevalence of depression and anxiety among patients with AF varies with sex, region, and evaluation scales, suggesting the need for psychological interventions for patients with AF in clinical practice.
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Affiliation(s)
- Shuai Zhang
- Department of Cardiology, LongHua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Na Zhang
- Department of Cardiology, LongHua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Liu Liu
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
| | - Wang Zheng
- Department of Cardiology, LongHua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Zi-Lin Ma
- Department of Cardiology, LongHua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Si-Yu Qiao
- Department of Cardiology, LongHua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Ying-Li Zhao
- Department of Cardiology, LongHua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Yi-Hong Wei
- Department of Cardiology, LongHua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Gang Wu
- Department of Cardiology, LongHua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Qiu-Ting Yu
- Department of Cardiology, LongHua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Bing Deng
- Department of Cardiology, LongHua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Lin Shen
- Department of Cardiology, LongHua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
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Du M, Cheng T, Ye Y, Wei Y. Prevalence and Risk Factors of Postprocedure Depression in Patients with Atrial Fibrillation after Radiofrequency Ablation. Cardiol Res Pract 2023; 2023:4635336. [PMID: 38020945 PMCID: PMC10645489 DOI: 10.1155/2023/4635336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/02/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
Background Recent studies have shown a bidirectional relationship between atrial fibrillation (AF) and psychological depression. However, little is known about the prevalence of postprocedure depression (PPD) in patients with AF at the time of radiofrequency (RF) ablation. Objective To describe the prevalence and identify risk factors for PPD. Methods This was a prospective cohort study, including 428 AF patients who were willing to undergo the first catheter ablation in our hospital from 1st April to 30th December 2019. The primary outcome was PPD, which was determined by Hospital Anxiety and Depression Scale-Depression. Results The prevalence of PPD was 16.8% (72/428) in our cohort, without difference between men (16.0%, 41/256) and women (18.0%, 31/172) (P = 0.586) but with a great difference among different age groups (P = 0.016). On the univariable binary logistic regression analysis, age, a history of coronary heart disease, Observer's Assessment of Alertness/Sedation (OAA/S) score when ablating at the specific position, and OAA/S score when pulling out the catheter sheath were associated with PPD. Subsequent multivariable logistic regression analysis indicated only age (OR 0.96, 95% CI: 0.94-0.99, P < 0.01) and OAA/S score when ablating at the specific position (OR 0.58, 95% CI: 0.39-0.88, P = 0.01) were independently associated with PPD. Conclusion PPD is common in patients with AF after RF ablation. Younger age and lower OAA/S score when ablating at the specific position are its most significant risk factors. Intensive management of sedation may be of great importance for reducing PPD. This trial is registered with the Chinese Clinical Trial Registry (ChiCTR2200057810).
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Affiliation(s)
- Mingli Du
- Department of Nursing, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tieniu Cheng
- Department of Cardiology, Tongling People's Hospital, Tongling, Anhui, China
| | - Yutong Ye
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yong Wei
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Manolis TA, Manolis AA, Apostolopoulos EJ, Melita H, Manolis AS. Depression and atrial fibrillation in a reciprocal liaison: a neuro-cardiac link. Int J Psychiatry Clin Pract 2023; 27:397-415. [PMID: 37615537 DOI: 10.1080/13651501.2023.2248214] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/09/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVE To explore the reciprocal relationship of depression and atrial fibrillation (AF). METHODS A literature search was conducted in Pub Med, Scopus, and Google Scholar using relevant terms for depression and AF and respective therapies. RESULTS There is evidence that depression is involved in the aetiology and prognosis of AF. AF, independently of its type, incurs a risk of depression in 20-40% of patients. Also, depression significantly increases cumulative incidence of AF (from 1.92% to 4.44% at 10 years); 25% increased risk of new-onset AF is reported in patients with depression, reaching 32% in recurrent depression. Hence, emphasis is put on the importance of assessing depression in the evaluation of AF and vice versa. Persistent vs paroxysmal AF patients may suffer from more severe depression. Furthermore, depression can impact the effectiveness of AF treatments, including pharmacotherapy, anticoagulation, cardioversion and catheter ablation. CONCLUSIONS A reciprocal association of depression and AF, a neurocardiac link, has been suggested. Thus, strategies which can reduce depression may improve AF patients' course and treatment outcomes. Also, AF has a significant impact on risk of depression and quality of life. Hence, effective antiarrhythmic therapies may alleviate patients' depressive symptoms. KEY POINTSAF, independently of its type of paroxysmal, permanent or chronic, appears to have mental besides physical consequences, including depression and anxietyA reciprocal influence or bidirectional association of depression and AF, a neurocardiac link, has been suggestedAF has considerable impact on the risk of depression occurrence with 20-40% of patients with AF found to have high levels of depressionAlso, depression significantly increases 10-year cumulative incidence and risk of AF from 1.92% to 4.44% in people without depression, and the risk of new-onset AF by 25-32%Emphasis should be placed on the importance of assessing depression in the evaluation of AF and vice versaPersistent/chronic AF patients may suffer from more severe depressed mood than paroxysmal AF patients with similar symptom burdenDepression and anxiety can impact the effectiveness of certain AF treatments, including pharmacotherapy, anticoagulation treatment, cardioversion and catheter ablationThus, strategies which can reduce anxiety and depression may improve AF patients' course and treatment outcomesAlso, effective antiarrhythmic therapies to control AF may alleviate patients' depressive mood.
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7
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Wang L, Ding C. Major depression disorder may causally associate with the increased atrial fibrillation risk: evidence from two-sample mendelian randomization analyses. BMC Med Genomics 2023; 16:144. [PMID: 37353760 PMCID: PMC10288724 DOI: 10.1186/s12920-023-01565-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 05/31/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND Observational studies have revealed a link between major depressive disorder (MDD) and a higher chance of developing atrial fibrillation (AF). It is still uncertain whether or not this correlation indicates a causal relationship. This research set out to evaluate the causal impact of MDD on AF. METHODS To evaluate the causal relationship between MDD and AF, we employed a two-sample Mendelian randomization (MR) method. A new genome-wide association study (GWAS) with 500,199 participants was used to obtain an overview of the association of genetic variations with MDD. An additional GWAS incorporating 1,030,836 people provided data on the relationship between gene variants and AF. The inverse-variance weighted technique was utilized to assess the effect sizes. Sensitivity analysis included the use of other statistical approaches such as weighted median, Outlier, MR Pleiotropy Residual Sum, weighted mode, simple mode, and MR - Egger. RESULTS By employing 47 single nucleotide polymorphisms (SNPs) as markers, MR analyses in random-effect inverse-variance weighted models found that genetically projected MDD was linked to an elevated incidence of AF (odds ratio [OR] = 1.098, 95% CI 1.000-1.206; P = 0.049). No gene pleiotropy was discovered as indicated by MR-Egger (intercept= -0.011, P = 0.169). Sensitivity analysis employing other MR techniques yielded reliable results. CONCLUSION This MR study established a causal relationship between genetically predicted MDD and an elevated risk of AF.
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Affiliation(s)
- Lei Wang
- Cardiac Department, Aerospace Center Hospital, 15 Yuquan Road, Haidian District, Beijing, 100049, PR China
| | - Chunhua Ding
- Cardiac Department, Aerospace Center Hospital, 15 Yuquan Road, Haidian District, Beijing, 100049, PR China.
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Sessions AJ, May HT, Crandall BG, Day JD, Cutler MJ, Groh CA, Navaravong L, Ranjan R, Steinberg BA, Jared Bunch T. Response to "Delay in AF ablation costs lives". J Cardiovasc Electrophysiol 2023; 34:1094-1095. [PMID: 36864718 DOI: 10.1111/jce.15878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 02/20/2023] [Indexed: 03/04/2023]
Affiliation(s)
| | - Heidi T May
- Department of Cardiology, Intermountain Medical Center, Intermountain Heart Institute, Salt Lake City, Utah, USA
| | - Brian G Crandall
- Department of Cardiology, Intermountain Medical Center, Intermountain Heart Institute, Salt Lake City, Utah, USA
| | - John D Day
- Department of Cardiology, St. Marks Hospital, Utah, Salt Lake City, USA
| | - Michael J Cutler
- Department of Cardiology, Intermountain Medical Center, Intermountain Heart Institute, Salt Lake City, Utah, USA
| | - Christopher A Groh
- Department of Internal Medicine, Division of Cardiology, University Hospital, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Leenapong Navaravong
- Department of Internal Medicine, Division of Cardiology, University Hospital, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Ravi Ranjan
- Department of Internal Medicine, Division of Cardiology, University Hospital, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Benjamin A Steinberg
- Department of Internal Medicine, Division of Cardiology, University Hospital, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - T Jared Bunch
- Department of Internal Medicine, Division of Cardiology, University Hospital, University of Utah School of Medicine, Salt Lake City, Utah, USA
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Cang J, Shi N, Zhu D, Liu Y, Zhou Q, Chen L. Self-reported sleep pattern and recurrence of atrial fibrillation after catheter ablation. Clin Cardiol 2023; 46:336-344. [PMID: 36648075 PMCID: PMC10018108 DOI: 10.1002/clc.23975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/20/2022] [Accepted: 01/04/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Increasing evidence has shown the relationship between sleep and the recurrence of atrial fibrillation (AF). However, the association of different sleep patterns with AF recurrence after catheter ablation was rarely studied. We aimed to assess the role of different sleep behaviors in the risk of AF recurrence after catheter ablation. METHODS AND RESULTS A total of 416 consecutive participants from Zhongda hospital of Southeast University were finally analyzed. Sleep patterns were defined by chronotype, sleep duration, insomnia, snoring, and daytime sleepiness. A total of 208 patients (50.0%) had a healthy sleep pattern within a mean follow-up of 32.42 ± 18.18 months. The observed number of patients with AF recurrence was 10 (50.0%), 80 (42.6%), and 40 (19.2%) in unhealthy, intermediate and healthy sleep groups, respectively (p < .01). After adjusting covariates, unhealthy sleep pattern was significantly associated with AF recurrence [hazard ratio = 3.47 (95% confidence interval CI: 1.726-6.979, p < .001)]. Sleep disorders such as inadequate sleep time (time <7 h or >8 h), insomnia and excessive sleepiness during daytime were associated with a higher risk of recurrence. Otherwise, improvement in sleep seemed to be associated with decreased risk of AF recurrence. CONCLUSION This retrospective study indicates that adherence to a healthy sleep pattern is associated with a lower risk of AF recurrence. Also, improved sleep before ablation is associated with a lower risk of AF recurrence.
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Affiliation(s)
- Jiehui Cang
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Naiyang Shi
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China.,Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, China
| | - Didi Zhu
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Yaowu Liu
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Qianxing Zhou
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Long Chen
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
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Charitakis E, Dragioti E, Stratinaki M, Korela D, Tzeis S, Almroth H, Liuba I, Jönsson AH, Charalambous G, Karlsson LO, Tsartsalis D. Predictors of recurrence after catheter ablation and electrical cardioversion of atrial fibrillation: an umbrella review of meta-analyses. Europace 2023; 25:40-48. [PMID: 36037026 PMCID: PMC10103559 DOI: 10.1093/europace/euac143] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 07/08/2022] [Indexed: 11/14/2022] Open
Abstract
AIMS The recurrence rates after catheter ablation (CA) and direct current (DC) cardioversion remain high, although they have been established treatments of rhythm control of atrial fibrillation (AF). This umbrella review systematically appraises published meta-analyses of both observational and randomized controlled trials (RCTs) for the association of risk and protective factors for arrhythmia recurrence after CA and DC cardioversion of AF. METHODS AND RESULTS Three bibliographic databases were searched up to June 2021. Evidence of association was rated as convincing, highly suggestive, suggestive, weak, or not significant with respect to observational studies and as high, moderate, low, or very low with respect to RCTs, according to established criteria. Thirty-one meta-analyses were included. Of the 28 associations between CA and the risk of arrhythmia recurrence, none presented convincing evidence, and only the time from diagnosis to ablation over 1 year provided highly suggestive evidence. The association between hypertension and metabolic profile provided suggestive evidence. The associations of Class IC and III antiarrhythmic drugs use with the recurrence after DC cardioversion were supported by an intermediate level of evidence. CONCLUSION Although AF is a major health issue, few risk- and protective factors for AF recurrence have been identified. None of these factors examined were supported by convincing evidence, whereas established factors such as female gender and left atrial volume showed only weak association. An early CA strategy combined with treatment of metabolic syndrome and hypertension prior to CA may reduce the risk of arrhythmia recurrence. The use of antiarrhythmics can increase the success rate of DC cardioversion. SYSTEMATIC REVIEW REGISTRATION PROSPERO registry number: CRD42021270613.
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Affiliation(s)
- Emmanouil Charitakis
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping 58185, Sweden
| | - Elena Dragioti
- Pain and Rehabilitation Centre and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping 58758, Sweden
| | - Maria Stratinaki
- Department of Cardiology, Venizeleio General Hospital, Heraklion, Crete 71409, Greece
| | - Dafni Korela
- Department of Cardiology, Venizeleio General Hospital, Heraklion, Crete 71409, Greece
| | | | - Henrik Almroth
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping 58185, Sweden
| | - Ioan Liuba
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping 58185, Sweden
| | - Anders Hassel Jönsson
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping 58185, Sweden
| | - Georgios Charalambous
- Department of Emergency Medicine, 'Hippokration' Hospital, Athens, Vasilissis Sofias 114, 11527 Athens, Greece
| | - Lars O Karlsson
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping 58185, Sweden
| | - Dimitrios Tsartsalis
- Department of Emergency Medicine, 'Hippokration' Hospital, Athens, Vasilissis Sofias 114, 11527 Athens, Greece
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11
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Wu H, Li C, Li B, Zheng T, Feng K, Wu Y. Psychological factors and risk of atrial fibrillation: A meta-analysis and systematic review. Int J Cardiol 2022; 362:85-92. [PMID: 35618103 DOI: 10.1016/j.ijcard.2022.05.048] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/15/2022] [Accepted: 05/20/2022] [Indexed: 12/26/2022]
Abstract
BACKGROUND Multiple studies have shown that mental disorders are common risk factors for cardiovascular diseases (CVD). However, the relationship between psychological factors and atrial fibrillation (AF) incidence remains unclear. Therefore, we performed a systematic review and meta-analysis to assess the risk of AF due to psychological factors. METHODS PubMed, Embase, Web of Science, and Cochrane Library were searched from inception to January 2022. Relevant and eligible cohort studies were included. Random or fixed effect model was used to estimate the pooled hazard ratios (HRs) and 95% confidence intervals (CIs). For non-randomized studies, the risk of bias was assessed using the Newcastle-Ottawa Scale (NOS). RESULTS Thirteen publications, including 5,329,908 participants, met our inclusion criteria. The incidence of AF was increased by 10% (HR = 1.10, 95% CI 1.02 to 1.19, I2 = 33.6%, P = 0.013, n = 235,599 in 6 studies) for patients with anxiety, by 15% (HR = 1.15, 95% CI 1.04 to 1.26, I2 = 40.2%, P = 0.04, n = 21,791 in 3 studies) for patients with anger, by 25% (HR = 1.25, 95% CI 1.12 to 1.39, I2 = 57.4%, P < 0.001, n = 5,160,247 in 6 studies) for patients with depression, and by 18% (HR = 1.18, 95% CI 1.05 to 1.32, I2 = 19.2%, P = 0.004, n = 51,664 in 4 studies) for people under work stress. CONCLUSIONS Adverse psychological factors such as anxiety, anger, depression, and work stress may increase the risk of AF. Interventions to prevent mental disorders may reduce the growing global burden of AF and its associated healthcare costs. Given the current study's limitations, our findings need to be further confirmed by a larger prospective study.
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Affiliation(s)
- Hao Wu
- Department of Cardiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Chenxing Li
- Department of Cardiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Bolin Li
- Department of Cardiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Tao Zheng
- Department of Cardiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Kaiyue Feng
- Department of Cardiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Yue Wu
- Department of Cardiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China.
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12
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Yao Y, Yang M, Liu D, Zhao Q. Immune remodeling and atrial fibrillation. Front Physiol 2022; 13:927221. [PMID: 35936905 PMCID: PMC9355726 DOI: 10.3389/fphys.2022.927221] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
Atrial fibrillation (AF) is a highly prevalent arrhythmia that causes high morbidity and mortality. However, the underlying mechanism of AF has not been fully elucidated. Recent research has suggested that, during AF, the immune system changes considerably and interacts with the environment and cells involved in the initiation and maintenance of AF. This may provide a new direction for research and therapeutic strategies for AF. In this review, we elaborate the concept of immune remodeling based on available data in AF. Then, we highlight the complex relationships between immune remodeling and atrial electrical, structural and neural remodeling while also pointing out some research gaps in these field. Finally, we discuss several potential immunomodulatory treatments for AF. Although the heterogeneity of existing evidence makes it ambiguous to extrapolate immunomodulatory treatments for AF into the clinical practice, immune remodeling is still an evolving concept in AF pathophysiology and further studies within this field are likely to provide effective therapies for AF.
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Affiliation(s)
- Yajun Yao
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Cardiovascular Research Institute of Wuhan University, Wuhan, China
- Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Mei Yang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Cardiovascular Research Institute of Wuhan University, Wuhan, China
- Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Dishiwen Liu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Cardiovascular Research Institute of Wuhan University, Wuhan, China
- Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Qingyan Zhao
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Cardiovascular Research Institute of Wuhan University, Wuhan, China
- Hubei Key Laboratory of Cardiology, Wuhan, China
- *Correspondence: Qingyan Zhao,
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13
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Yoshihisa A, Kono S, Kaneshiro T, Ichijo Y, Misaka T, Yamada S, Oikawa M, Miura I, Yabe H, Takeishi Y. Impaired brain activity in patients with persistent atrial fibrillation assessed by near-infrared spectroscopy and its changes after catheter ablation. Sci Rep 2022; 12:7866. [PMID: 35550598 PMCID: PMC9098845 DOI: 10.1038/s41598-022-12097-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 04/25/2022] [Indexed: 11/21/2022] Open
Abstract
Although the prevalence of cognitive impairment and depression is higher in patients with atrial fibrillation (AF) than in the general population, the mechanism has not been fully examined and impact of catheter ablation (CA) of AF also remains unclear. Recently, the development of near-infrared spectroscopy (NIRS) has enabled noninvasive measurements of regional cerebral blood volume and brain activity, in terms of cerebral oxyhemoglobin in the cerebral cortex. We assessed brain activities by NIRS, depressive symptoms by the Center for Epidemiologic Studies Depression Scale (CES-D) and cognitive function by Mini-Mental State Examination (MMSE). We then compared the results between AF patients (paroxysmal AF n = 18 and persistent AF n = 14) and control subjects (n = 29). Next, we also followed up persistent AF patients who kept sinus rhythm at 3 months after CA (n = 8) and measured their brain activities using NIRS, CES-D and MMSE after CA to investigate the associations of changes in brain activities with changes in both CES-D and MMSE. Our results showed that (1) frontal and temporal brain activities were lower in patients with persistent AF than both in control subjects and paroxysmal AF patients (P < 0.01), (2) frontal and temporal brain activities were improved in more than half of the persistent AF patients who kept sinus rhythm at 3 months after CA, especially in those who presented impaired brain activity before CA, and (3) improvement of frontal brain activity was associated with improvement of CES-D (R = − 0.793, P = 0.019), whereas improvement of temporal brain activity was associated with improvement of MMSE (R = 0.749, P = 0.033). NIRS measurement showed reduced frontal and temporal brain activities in the persistent AF patients, CA improved frontal and temporal brain activities in some of these patients, and associated with improvement of depressive state and/or improvement of cognitive function.
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Affiliation(s)
- Akiomi Yoshihisa
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan. .,Department of Clinical Laboratory Sciences, Fukushima Medical University School of Health Science, Fukushima, Japan.
| | - Soichi Kono
- Department of Neuropsychiatry, Fukushima Medical University, Fukushima, Japan
| | - Takashi Kaneshiro
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Yasuhiro Ichijo
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Tomofumi Misaka
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Shinya Yamada
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Masayoshi Oikawa
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Itaru Miura
- Department of Neuropsychiatry, Fukushima Medical University, Fukushima, Japan
| | - Hirooki Yabe
- Department of Neuropsychiatry, Fukushima Medical University, Fukushima, Japan
| | - Yasuchika Takeishi
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
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Pavlicek V, Wedegärtner SM, Millenaar D, Wintrich J, Böhm M, Kindermann I, Ukena C. Heart-Focused Anxiety, General Anxiety, Depression and Health-Related Quality of Life in Patients with Atrial Fibrillation Undergoing Pulmonary Vein Isolation. J Clin Med 2022; 11:jcm11071751. [PMID: 35407359 PMCID: PMC8999774 DOI: 10.3390/jcm11071751] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/11/2022] [Accepted: 03/16/2022] [Indexed: 02/06/2023] Open
Abstract
(1) Background: Atrial fibrillation (AF) is associated with anxiety, depression, and chronic stress, and vice versa. The purpose of this study was to evaluate potential effects of pulmonary vein isolation (PVI) on psychological factors. (2) Methods: Psychological assessment was performed before PVI as well as after six months. (3) Results: A total of 118 patients [age 64 ± 9 years, 69% male, left ventricular ejection fraction 57 ± 8%, 56% paroxysmal AF] undergoing PVI were included. After PVI, significant improvements were observed in the mean total heart-focused anxiety (HFA) score, as well as in the Cardiac Anxiety Questionnaire (CAQ) sub-scores: HFA attention, HFA fear, and HFA avoidance scores. Subgroup analyses showed an association of improvement with freedom of documented AF recurrence. Mean scores of general anxiety and depression evaluated by the Hospital Anxiety and Depression Scale (HADS) decreased significantly after PVI in all subgroups regardless of AF recurrence. Further, both physical and mental composite scores of the Short Form Health Survey (SF-12) increased significantly from baseline. (4) Conclusions: PVI results in a significant reduction in HFA. Improvements in general anxiety and depressive symptoms did not seem to be related only to rhythm control per se. Therefore, CAQ may represent a more specific evaluation tool as HADS in patients with AF.
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15
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Ai Y, Xing Y, Yan L, Ma D, Gao A, Xu Q, Zhang S, Mao T, Pan Q, Ma X, Zhang J. Atrial Fibrillation and Depression: A Bibliometric Analysis From 2001 to 2021. Front Cardiovasc Med 2022; 9:775329. [PMID: 35252380 PMCID: PMC8888833 DOI: 10.3389/fcvm.2022.775329] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 01/18/2022] [Indexed: 01/13/2023] Open
Abstract
BackgroundThe control of diseases related to atrial fibrillation (AF) may reduce the occurrence of AF, delay progression, and reduce complications, which is beneficial to the prevention and treatment of AF. An increasing number of studies have shown that AF is associated with depression. However, to date, there has not been a bibliometric analysis to examine this field systematically. Our study aimed to visualize the publications to determine the hotspots and frontiers in research on AF and depression and provide guidance and reference for further study.MethodsPublications about AF and depression between 2001 and 2021 were retrieved from the Web of Science Core Collection (WOSCC) database. CiteSpace 5.8. R1, VOSviewer 1.6.16, and Excel 2019 software tools were used to conduct this bibliometric study.ResultsIn total, 159 articles and reviews were analyzed. The number of publications has been increased sharply since 2018. David D. McManus had the largest number of publications. The most prolific country was the USA with 54 publications but the centrality was <0.1. The most prolific institution was Northeastern University. Three clusters were formed based on keywords: The first cluster was composed of atrial fibrillation, depression, anxiety, symptoms, ablation, and quality of life, et al. The second cluster were risk, prevalence, mortality, heart failure, association, et al. While the third cluster included anticoagulation, impact, stroke, management, warfarin, et al. After 2019, stroke and prediction are the keywords with strongest citation bursts.ConclusionResearch on AF and depression is in its infancy. Cooperation and exchanges between countries and institutions must be strengthened in the future. The effect of depression on prevalence and mortality in AF, depression on ablation in AF, and impact of depression on anticoagulation treatment in AF have been the focus of current research. Stroke prevention (including anticoagulant therapy) is the research frontier, which may still be the focus of research in the future.
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Affiliation(s)
- Yuzhen Ai
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yaxuan Xing
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Longmei Yan
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Dan Ma
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Anran Gao
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Qiwu Xu
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Shan Zhang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Ting Mao
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Qiu Pan
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xiaojuan Ma
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- *Correspondence: Xiaojuan Ma
| | - Jingchun Zhang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Jingchun Zhang
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16
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Shan Q, Xinxin S, Zhijuan X, Rongjing D, Minjie Z. Effects of Cognitive Behavior Therapy on Depression, Illness Perception, and Quality of Life in Atrial Fibrillation Patients. Front Psychiatry 2022; 13:830363. [PMID: 35599772 PMCID: PMC9120611 DOI: 10.3389/fpsyt.2022.830363] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 02/14/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND AF Patients with depression resulted in a markedly reduced quality of life. The purpose of this study was to evaluate the efficacy of cognitive behavior therapy (CBT) on the health-related quality of life (HRQoL). METHODS It was A longitudinal randomized controlled trial with a pre and 12-weeks post-test. Ninety persons were randomly assigned to either a CBT group (CBT) (n = 45) or a treatment as usual (TAU) group (n = 45). The outcome were changes in the HRQoL [12-item Short Form Health Survey, SF12, divided into two domains: the physical component summary (PCS) and the mental component summary (MCS)], changes in psychological distress [Hamilton Depression Rating Scale (HAM-D) and Patient Health Questionnaire-9 (PHQ-9)], and Illness Perception [Brief Illness Perception Questionnaire (BIPQ)]. RESULTS There were statistically significant differences in score reduction for PHQ-9 (t = 3.186, P = 0.002), HAMD (t = 2.611, P = 0.011), BIPQ (t = 7.660, P < 0.001), and MCS (t = 4.301, P < 0.001) between CBT group and TAU group. CONCLUSIONS CBT improved HRQoL, Illness Perception and reduced Depressive symptoms in atrial fibrillation.
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Affiliation(s)
- Qu Shan
- Department of Psychiatry, Peking University People's Hospital, Beijing, China
| | - Shi Xinxin
- Department of Psychiatry, Peking University People's Hospital, Beijing, China
| | - Xie Zhijuan
- Department of Psychiatry, Peking University People's Hospital, Beijing, China
| | - Ding Rongjing
- Department of Cardiology, Peking University People's Hospital, Beijing, China
| | - Zheng Minjie
- Department of Psychiatry, Peking University People's Hospital, Beijing, China
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Abstract
Objective: Cardiovascular diseases are associated with an increased risk of depression, but it remains unclear whether treatment with cardiovascular agents decreases or increases this risk. The effects of drugs on individual usage are also often unknown. This review aimed to examine the correlation between depression and common cardiovascular drugs, develop more potent interventions for depression in cardiovascular patients, and further research on the bio-behavioural mechanisms linking cardiovascular drugs to depression. Data sources: The data in this review were obtained from articles included in PubMed, EMBASE, and Web of Science. Study selection: Clinical trials, observational studies, review literature, and guidelines about depression and cardiovascular drugs were selected for the article. Results: We systematically investigated whether the seven most used cardiovascular drugs were associated with altered risk of incident depression in this literature review. Statins have been proven to have antidepressant effects. Some studies believe angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blocker (ARB) can exert an antidepressant influence by acting on the renin-angiotensin system, but further clinical trials are needed to confirm this. Beta-blockers have previously been associated with depression, but the current study found no significant association between beta blockers and the risk of depression. Aspirin may have antidepressant effects by suppressing the immune response, but its role as an antidepressant remains controversial. calcium channel blockers (CCBs) can regulate nerve signal transduction by adjusting calcium channels, but whether this effect is beneficial or harmful to depression remains unclear. Finally, some cases have reported that nitrates and diuretics are associated with depression, but the current clinical evidence is insufficient. Conclusions: Statins have been proven to have antidepressant effect, and the antidepressant effects of ACEIs/ARB and aspirin are still controversial. CCBs are associated with depression, but it is unclear whether it is beneficial or harmful. No association has been found with β-blockers, diuretics, and nitrates.
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