TY - JOUR

T1 - Dyspnea in patients with atrial fibrillation

T2 - Mechanisms, assessment and an interdisciplinary and integrated care approach

AU - van der Velden, Rachel M.J.

AU - Hermans, Astrid N.L.

AU - Pluymaekers, Nikki A.H.A.

AU - Gawalko, Monika

AU - Elliott, Adrian

AU - Hendriks, Jeroen M.

AU - Franssen, Frits M.E.

AU - Slats, Annelies M.

AU - van Empel, Vanessa P.M.

AU - Van Gelder, Isabelle C.

AU - Thijssen, Dick H.J.

AU - Eijsvogels, Thijs M.H.

AU - Leue, Carsten

AU - Crijns, Harry J.G.M.

AU - Linz, Dominik

AU - Simons, Sami O.

N1 - Publisher Copyright: © 2022

PY - 2022

Y1 - 2022

N2 - Atrial fibrillation (AF) is the most common sustained heart rhythm disorder and is often associated with symptoms that can significantly impact quality of life and daily functioning. Palpitations are the cardinal symptom of AF and many AF therapies are targeted towards relieving this symptom. However, up to two-third of patients also complain of dyspnea as a predominant self-reported symptom. In clinical practice it is often challenging to ascertain whether dyspnea represents an AF-related symptom or a symptom of concomitant cardiovascular and non-cardiovascular comorbidities, since common AF comorbidities such as heart failure and chronic obstructive pulmonary disease share similar symptoms. In addition, therapeutic approaches specifically targeting dyspnea have not been well validated. Thus, assessing and treating dyspnea can be difficult. This review describes the latest knowledge on the burden and pathophysiology of dyspnea in AF patients. We discuss the role of heart rhythm control interventions as well as the management of AF risk factors and comorbidities with the goal to achieve maximal relief of dyspnea. Given the different and often complex mechanistic pathways leading to dyspnea, dyspneic AF patients will likely profit from an integrated multidisciplinary approach to tackle all factors and mechanisms involved. Therefore, we propose an interdisciplinary and integrated care pathway for the work-up of dyspnea in AF patients.

AB - Atrial fibrillation (AF) is the most common sustained heart rhythm disorder and is often associated with symptoms that can significantly impact quality of life and daily functioning. Palpitations are the cardinal symptom of AF and many AF therapies are targeted towards relieving this symptom. However, up to two-third of patients also complain of dyspnea as a predominant self-reported symptom. In clinical practice it is often challenging to ascertain whether dyspnea represents an AF-related symptom or a symptom of concomitant cardiovascular and non-cardiovascular comorbidities, since common AF comorbidities such as heart failure and chronic obstructive pulmonary disease share similar symptoms. In addition, therapeutic approaches specifically targeting dyspnea have not been well validated. Thus, assessing and treating dyspnea can be difficult. This review describes the latest knowledge on the burden and pathophysiology of dyspnea in AF patients. We discuss the role of heart rhythm control interventions as well as the management of AF risk factors and comorbidities with the goal to achieve maximal relief of dyspnea. Given the different and often complex mechanistic pathways leading to dyspnea, dyspneic AF patients will likely profit from an integrated multidisciplinary approach to tackle all factors and mechanisms involved. Therefore, we propose an interdisciplinary and integrated care pathway for the work-up of dyspnea in AF patients.

KW - Atrial fibrillation

KW - Comorbidities

KW - Dyspnea

KW - Exercise intolerance

KW - Mechanisms

KW - Symptom assessment

UR - http://www.scopus.com/inward/record.url?scp=85134699216&partnerID=8YFLogxK

U2 - 10.1016/j.ijcha.2022.101086

DO - 10.1016/j.ijcha.2022.101086

M3 - Review

C2 - 35873859

AN - SCOPUS:85134699216

VL - 42

JO - IJC Heart and Vasculature

JF - IJC Heart and Vasculature

SN - 2352-9067

M1 - 101086

ER -