Dyspnea in patients with atrial fibrillation: Mechanisms, assessment and an interdisciplinary and integrated care approach

Rachel M J van der Velden, Astrid N L Hermans, Nikki A H A Pluymaekers, Monika Gawalko, Adrian Elliott, Jeroen M Hendriks, Frits M E Franssen, Annelies M Slats, Vanessa P M van Empel, Isabelle C Van Gelder, Dick H J Thijssen, Thijs M H Eijsvogels, Carsten Leue, Harry J G M Crijns, Dominik Linz*, Sami O Simons

*Corresponding author for this work

Research output: Contribution to journal(Systematic) Review article peer-review


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.

Original languageEnglish
Article number101086
Number of pages7
JournalIJC Heart and Vasculature
Publication statusPublished - Oct 2022


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