Should you track your atrial fibrillation triggers?

The hallmark sign of atrial fibrillation — a chaotic, racing heartbeat—often comes and goes. Episodes may last anywhere from seconds to hours or even days before the heart rate spontaneously returns to normal. Some people with this form of atrial fibrillation — known as paroxysmal or intermittent afib — don't even realize they have the disorder. But others experience a host of unpleasant symptoms, including breathlessness, dizziness, anxiety, weakness, fainting, confusion, and fatigue.

People with afib often wonder whether certain habits — such as drinking coffee or not getting sufficient sleep — might trigger their episodes. That curiosity inspired a collaborative clinical trial between researchers and patients to see whether pinpointing individual, personalized triggers was possible and potentially helpful (see "Alcohol — not caffeine — fingered as common afib trigger").

Some people are exquisitely sensitive to caffeine, but most are not, says Dr. Zimetbaum. "I tell my patients that it's fine to have small amounts of caffeine because the link between caffeine and afib is quite weak," he says. As for alcohol, binge drinking (consuming large amounts of alcohol in a short time) is a well-known afib trigger. But evidence increasingly suggests that smaller amounts of alcohol, even just one drink, may also raise a person's risk, and some people may be more susceptible than others.

Fruitless and frustrating?

Much of the media coverage of this study quoted doctors who suggested that people with afib experiment on themselves to identify their afib triggers. But that's not necessarily a good idea.

"It's mostly an exercise in frustration," says Dr. Peter Zimetbaum, professor of cardiovascular medicine at Harvard Medical School and a specialist in heart rhythm disorders. When people try to identify their triggers, they spend a lot of time being hypervigilant about everything they do. More often than not, they can't find any correlation between their habits and when they experience afib, he explains. That level of vigilance often ends up increasing their stress levels. If they do identify potential triggers, they may find that avoiding triggers doesn't always help. That perceived lack of control can also heighten stress levels.

Routine disruptions?

However, people may recognize certain patterns to their afib episodes. Some notice that disruptions to their normal routine are likely to trigger a bout of afib — for example, exhaustion due to jet lag or indigestion after eating a rich, heavy meal, says Dr. Zimetbaum. These problems perturb the body's autonomic nervous system, the network of nerves that control "automatic" functions, including your heart rate, breathing, and digestion.

But when it comes to common habits such as drinking coffee or alcohol, it's hard to disentangle their effects from the myriad other factors intertwined with those habits, Dr. Zimetbaum says. These include environmental elements (the time of day or day of the week) or behavioral reasons (a desire to either wake up or relax).

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