Lifestyle changes are important for managing atrial fibrillation

Atrial fibrillation (afib) is a common heart rhythm disorder in which the upper chambers of the heart (the atria) beat fast and irregularly. Afib commonly causes recurrent symptoms, usually palpitations and shortness of breath, and can negatively affect quality of life. Afib also substantially increases the risk of stroke, and is also associated with heart failure, high blood pressure, and diabetes. People with afib routinely require lifelong treatment with blood thinners, to prevent blood clots that can lead to strokes.

Doctors are only recently understanding the importance of lifestyle factors in treating afib. Modifiable lifestyle factors are so important and under-recognized that the American Heart Association (AHA) recently released a scientific statement summarizing the latest research on this topic. The AHA wants both doctors and patients to understand the relationship between lifestyle and afib, and to work as a team to put these lifestyle factors into practice. Following is a discussion of important lifestyle factors, how they may impact afib, and what you can do.

Obesity

One of the strongest factors associated with afib is body weight. Obesity (defined as body mass index [BMI] > 30) has been shown in multiple studies to be linked to the development of afib. Obesity is associated with changes to electrical signaling within the atria, as well as structural changes to the heart’s upper chambers. Overeating can also cause inflammation via changes in hormone and cell-signaling pathways in the atria. Several studies have shown that as we gain weight, fat is deposited in the heart (as well as other places throughout the body), and this can trigger arrhythmias, most commonly afib.

Obesity can also be a cause of new or worsening hypertension (high blood pressure), which promotes further structural changes in the heart. Obesity also can cause obstructive sleep apnea and diabetes, both of which independently increase risk of afib.

The good news is that for people who are overweight or obese, just a 10% reduction in weight seems to improve symptoms related to afib.

Exercise

For decades cardiologists have encouraged people to exercise, because exercise reduces the risk of dying from cardiovascular causes. Not only is exercise good, but physical inactivity is actually detrimental; a sedentary lifestyle contributes to afib and may actually be an independent predictor of this condition. The AHA recommends 150 minutes per week of moderate-intensity aerobic exercise, or 75 minutes per week of vigorous-intensity aerobic exercise, to improve cardiovascular health. Regular exercise helps to prevent atrial fibrillation and, if you already have afib, reduces symptoms and improves afib-related quality of life.

If you are not already exercising, talk to your physician about starting a low-intensity exercise program. Brisk walking is a great form of moderate exercise and allows for physical distancing. Start with 20 minutes a day and gradually increase your pace and duration to achieve at least 150 minutes per week of moderate-intensity activity.

Sleep disorders

Obstructive sleep apnea (OSA) is a sleep disorder in which people stop breathing for short periods while they are sleeping. It is the most common form of sleep-disordered breathing and is strongly associated with cardiovascular disease. There is also a very high prevalence of OSA in people with afib, and recurrence of afib symptoms is higher in people with more severe OSA.

Cardiologists now routinely screen people with recurrent afib symptoms for OSA. Treating OSA with continuous positive airway pressure (CPAP) appears to improve afib symptoms.

If you experience afib symptoms, ask your doctors if you should have a sleep study to check for OSA.

Alcohol

Alcohol is a known risk factor for atrial fibrillation, and there is mounting evidence that the old adage “less is more” may be true for drinking if you have afib. A recent study in the New England Journal of Medicine found less afib when patients decreased or abstained from alcohol.

If you have afib, try cutting back on alcohol, or even not drinking at all. Talk to your doctor if you are having trouble reducing your alcohol consumption.

Diabetes

The risk of afib is higher in patients with type 2 diabetes. While the mechanism is not well understood, it’s likely that elevated blood sugars directly damage the heart and promote structural, electrical, and autonomic changes within the heart tissue.

The good news is that better blood sugar control improves both the severity and frequency of afib symptoms. Lifestyle changes that promote exercise and limit inactivity can also help with weight loss and blood sugar control.

Diet

Dietary changes can translate into weight loss, and also help to control blood sugar if you have diabetes. Changing your diet can be challenging, but eating less processed foods and more fresh vegetables and fruit is a good starting place. Target bad habits, like snacking or eating out of boredom. And consider transitioning to a Mediterranean diet, which helps control weight, blood sugar, and blood pressure.