More research is needed to assess whether the relationship observed between arterial stiffness and symptom burden in atrial fibrillation (AF) is specific to this condition, according to an editorial published in the Canadian Journal of Cardiology.1

“Despite evolving evidence supporting the association between AF risk and arterial stiffness, the contribution of arterial stiffness to the variety and severity of symptoms in [patients with] AF remains unclear,” commented the authors of the editorial.

This editorial deals with a study by Kranert et al. published in the same issue in which investigators examined the association between arterial and AF-related symptoms in 162 patients with paroxysmal or persistent AF (ages, 66-80 years) and a high number of cardiovascular comorbidities.2 In this study, reduced aortic compliance — a surrogate for arterial stiffness — was found to be associated with a higher symptom burden in patients with AF.

“The authors postulate that the damping function of the aorta might play an essential role in the genesis of symptoms,” noted the authors of the editorial. “The work by Kranert et al. provides interesting insight in the association between vascular properties and symptom burden in patients with AF.”

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Female sex, diabetes, heart failure, end-stage renal disease, smoking, obesity, sleep apnea, heart rate, and dyslipidemia are independent predictors for arterial stiffness and may contribute to symptom burden in AF.

In the study by Kranert et al., symptomatic patients tended to be older, more likely to be women, and had higher CHA2DS2-VASc score, cardiovascular risk profile, and number of comorbidities. In a large prospective study of 614 patients with permanent AF, age, sex, and severity of the underlying disease were found to have an impact on quality of life.3

“The best way to assess symptoms in [patients with] AF, and particularly how to determine AF-related symptoms in [patients with] AF, remains unclear,” noted the editorialists.

“Kranert et al. are the first to show an association between arterial stiffness and symptom burden in patients with AF,” they concluded. “Appropriately designed prospective clinical trials are required to assess whether there is a causal relation between increased arterial stiffness and higher AF-related symptom burden, especially in a younger and healthier AF population, eg, patients with lone AF. Whether arterial stiffness should be routinely assessed in symptomatic patients with AF and whether arterial stiffness represents a modifiable factor for symptom control in AF patients warrants further study.”


  1. Hermans ANL, Andrade J, Linz D. Arterial stiffness association with symptom burden in patients with atrial fibrillation: Direct cause or marker of concomitant risk factors? [published online August 15, 2020]. Can J Cardiol. doi: 10.1016/j.cjca.2020.08.003
  2. Kranert M, Shchetynska-Marinova T, Berghoff T, et al. Arterial stiffness is associated with increased symptom burden in patients with atrial fibrillation. Can J Cardiol. doi: 10.1016/j.cjca.2020.08.022 Groenveld HF, Crijns HJGM, Van den Berg MP, et al. The effect of rate control on quality of life in patients with permanent atrial fibrillation. Data from the RACE II (Rate Control Efficacy in Permanent Atrial Fibrillation II) study. J Am Coll Cardiol. 2011;58:1795-803.