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The key drivers of symptom severity in atrial fibrillation (AF) patients remain unclear. The study aimed to explore associations between anxious and depressive status and AF-related symptoms as expressed by the modified European Heart Rhythm Association (mEHRA) score. The study enrolled 182 AF patients admitted to the Cardiology Department of Peking University Third Hospital between February 2017 to January 2020. Anxious and depressive status were assessed by "Generalized Anxiety Disorder-7" and "Patient Health Questionnaire-9," respectively. The severity of AF-related symptoms was scored by mEHRA and classified into 2 groups: low mEHRA group (mEHRA = 1 or 2a) and high mEHRA group (mEHRA ≥ 2b), according to whether they were troubled or affected by AF-related symptoms. In all 182 AF patients, 56.0% (n = 102) patients presented mEHRA ≥ 2b. The high mEHRA group had significantly higher Patient Health Questionnaire-9 score [4.0 (2.0-7.0) vs 2.5 (0-4.8), P < .001] and Generalized Anxiety Disorder-7 score [3 (0-5) vs 0 (0-3), P < .001]. After adjusted for other covariates, persistent AF (odds ratio, OR = 0.48, 95% confidence interval [CI]: 0.23, 0.99), heart failure (OR = 2.91, 95% CI: 1.08, 8.43), depressive status (OR = 2.15, 95% CI: 1.01, 4.65), and anxious status (OR = 2.83, 95% CI: 1.17, 7.38) were independently associated with high mEHRA score (≥2b). Increased anxiety and depression levels was associated with feeling troubled or limited by AF-related symptoms scored by mEHRA.