The Role of Psychological Stress in Atrial Fibrillation: Completing the Translational Circle from Molecular Mechanisms to Citizen Science

Abstract Atrial fibrillation (AF), the most common cardiac arrhythmia, affects over 33 million people worldwide and is associated with increased risks of stroke, heart failure, reduced quality of life, and mortality. In addition to established cardiovascular risk factors, accumulating evidence suggests that psychological stress and stress-related physiological changes may influence AF onset, progression, and recurrence. However, stress remains an underexplored target in preventive cardiology. This review summarizes current evidence on the relationship between psychological stress and AF, examining perceived stress, socioeconomic stressors, stressful life events, as well as their assessment. We discuss observational studies, highlighting stress as both a potential trigger and a modifier of disease course. A unique aspect of this review is the integration of patient perspectives inquired via Dutch online citizen science initiatives, in which individuals with lived experience of AF contributed data on perceived stress, symptom severity, and coping strategies. Collectively, the evidence indicates that psychological stress is a modifiable factor in perceived AF severity, and that combining citizen-reported experiences with biomarker research may open new avenues for further understanding, personalized prevention, patient empowerment, and holistic AF management.