Tim Süselbeck

Aims: Atrial fibrillation (AF) carries substantial psychosocial burden, but how psychosocial symptoms interrelate across AF subtypes and severities remains unclear. This study compared psychosocial symptom networks across time, AF type, and European Heart Rhythm Association (EHRA) class in the ARENA (Atrial Fibrillation Rhine-Neckar Region) cohort. Methods and results: Adults with AF were assessed at baseline (T0) and follow-up (T1). Analytic samples included 996 patients with EHRA class [asymptomatic (EHRA 1) vs. symptomatic (EHRA ≥ 2)] and 924 with AF subtype (paroxysmal, persistent, or permanent) data. Measures included anxiety and worry (GAD-2), cardiac worry and avoidance (CAQ-2), health-related quality of life (HRQoL) (EQ-5D-5L), and psychosocial stressors. Gaussian graphical models were estimated and compared using network comparison test. Global network structures were stable across EHRA classes, AF subtypes, and time points, but specific edges and node centralities varied. The most robust edges linked anxiety with general worry and cardiac worry with avoidance. Anxiety, general worry, cardiac worry, and diminished HRQoL were consistently the most central nodes. Among symptomatic (EHRA ≥ 2) patients, loneliness emerged as an increasingly central node over time, whereas among asymptomatic patients (EHRA 1), sleep problems showed a stronger association with HRQoL at follow-up. Atrial fibrillation–type network structures were similar, although paroxysmal networks showed higher node centrality and stronger anxiety–worry coupling at T0; persistent or permanent AF showed a stress-at-home–cardiac worry edge at T1. Conclusion: Psychosocial symptom networks in AF are comparable across subtypes and reveal intervention targets, particularly anxiety, cardiac worry with avoidance, loneliness, and sleep disturbance.

Background: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and is associated with impaired health-related quality of life (HRQoL), high symptom severity, and poor cardiovascular outcomes. Both clinical and psychological factors may contribute to symptom severity and HRQoL in AF. Methods: Using data from the observational Atrial Fibrillation Rhine-Neckar Region (ARENA) trial, we identified medical and psychosocial factors associated with AF-related symptom severity using European Heart Rhythm Association symptom classification and HRQoL using 5-level EuroQoL- 5D. Results: In 1218 AF patients (mean age 71.1 ± 10.5 years, 34.5% female), female sex (OR 3.7, p < 0.001), preexisting coronary artery disease (CAD) (OR 1.7, p = 0.020), a history of cardioversion (OR 1.4, p = 0.041), cardiac anxiety (OR 1.2; p < 0.001), stress from noise (OR 1.4, p = 0.005), work-related stress (OR 1.3, p = 0.026), and sleep disturbance (OR 1.2, p = 0.016) were associated with higher AF-related symptom severity. CAD (β = −0.23, p = 0.001), diabetes mellitus (β = −0.25, p < 0.001), generalized anxiety (β = −0.30, p < 0.001), cardiac anxiety (β = −0.16, p < 0.001), financial stress (β = −0.11, p < 0.001), and sleep disturbance (β = 0.11, p < 0.001) were associated with impaired HRQoL. Conclusions: Psychological characteristics, preexisting CAD, and diabetes may play an important role in the identification of individuals at highest risk for impaired HRQoL and high symptom severity in patients with AF.