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Review
. 2024 Aug 1;12(8):1719.
doi: 10.3390/biomedicines12081719.

Heart-Brain Axis: A Narrative Review of the Interaction between Depression and Arrhythmia

Shuping Fang  1 , Wei Zhang  1   2
Affiliations
Review

Heart-Brain Axis: A Narrative Review of the Interaction between Depression and Arrhythmia

Shuping Fang et al. Biomedicines. .

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.

Keywords: arrhythmia; autonomic nervous system; brain; depression; heart; interoception.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Anatomical and functional pathways of the heart and brain. Abbreviations: E: Epinephrine; NE: Norepinephrine.
Figure 2
Figure 2
External stress mediates depression and arrhythmia by affecting physiological changes within the body. Additionally, the activation of the SNS releases catecholamines, increasing myocardial excitability and vasoconstriction. Prolonged physiological changes lead to autonomic remodeling. The neuroendocrine system, closely linked with the ANS, including the HPA, HPT, and HPG axes, releases CRF, cortisol, thyroid hormones, and sex hormones, all of which play roles in the heart–brain relationship. The SNS and HPA axis also promote inflammatory responses, which interact to mediate emotional dysregulation. Furthermore, the cortical coupling of cardiac activity through baroreceptors is crucial in these processes. Genes and personality traits also play significant roles in this pathway. Abbreviations: SNS: Sympathetic Nervous System, ANS: Autonomic Nervous System, HPA: Hypothalamic-Pituitary-Adrenal, HPT: Hypothalamic-Pituitary-Thyroid, HPG: Hypothalamic-Pituitary-Gonadal, CRF: Corticotropin-Releasing Factor.
Figure 3
Figure 3
Sex differences in the prevalence of cardiac arrhythmias [69,109].
See this image and copyright information in PMC

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