TNF and Myocardial fibrosis: Depressive states are characterized by elevated levels ofinflammatory cytokines, such as interleukin-6, tumor necrosis factor-alpha, andC-reactive protein, which have been demonstrated to induce endothelialdysfunction, promote myocardial fibrosis, and enhance atrial and ventriculararrhythmogenicity through structural and electrical remodeling [37, 38].Furthermore, hypothalamic–pituitary–adrenal axis dysregulation in depressioncauses hypercortisolemia and heightened catecholamine release, furtheraggravating autonomic and inflammatory disturbances [39, 40].