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Causes of Atrial Fibrillation, A-Fib, afib, a fib

Causes of Atrial Fibrillation

What are the Causes of A-Fib?

Nearly five million people in the U.S. have A-Fib. By the year 2050, the number will be 12-16 million. 1  Each year there are over 340,000 new cases in the US. A-Fib is the most common heart arrhythmia. 2 In the U.S. people over 40 have a one in four lifetime risk of developing A-Fib. 3 Worldwide the number of cases is estimated to be around 600 million. 4 has rightly been called an epidemic. 5

HOW DO YOU GET A-FIB?

Heart Problems

If you’ve had other heart problems, this could lead to diseased heart tissue which generates the extra A-Fib pulses. Hypertension (high blood pressure), Mitral Valve disease, Congestive Heart Failure, coronary artery disease, and obesity 6 seem to be related to A-Fib, possibly because they stretch and put pressure on the pulmonary veins where most A-Fib originates. Coronary artery disease reduces blood flow and oxygen (stagnant hypoxia) which can trigger A-Fib. A lot of A-Fib seems to come from uncontrolled high blood pressure. Many EPs recommend that all hypertension patients get a home BP monitor and aggressively work at controlling their blood pressure. 

Many people (“up to 40% of patients” 7 “) get A-Fib after open heart surgery.

“Pericarditis”—inflammation of the pericardium, a sack-like membrane surrounding the heart—can lead to A-Fib.

If you have a stroke, according to Dr. Bernd KallmÜnzer, “About 25% to 35% of stroke survivors experience atrial fibrillation.” 8

Alcohol Consumption

Heavy drinking may trigger A-Fib, what hospitals call “holiday heart”—the majority of A-Fib admissions occur over weekends or holidays when more alcohol is consumed. No association was found between moderate alcohol use and A-Fib. 9 (Heavy drinking reduces the ability of cells to take up and utilize oxygen [histotoxic hypoxia] which in some people may produce or trigger A-Fib. [Thanks to Warren Stuart for this insight.])

But if you already have A-Fib, even moderate use may trigger an A-Fib attack, “…people with atrial fibrillation had almost a four and a half greater chance of having an episode if they were consuming alcohol than if they were not.” 10 (Thanks to David Holzman for calling our attention to this article.)

Otherwise healthy middle-aged women who consumed more than 2 drinks daily were 60% more likely to develop AF. 11

Steve Walters writes that red wine brings on A-Fib attacks for him, but not beer, white wine, or cordials. Has anyone else had similar experiences with red wine? E-mail: bicwiley(at)gmail.com.

Neville writes that taking a heavy dose of Magnesium/Potassium tablets and bananas for breakfast kept him out of A-Fib during a golfing weekend with significant drinking. He uses the same strategy to get out of an A-Fib attack. mfa@optusnet.com.au 

Severe Body & Mind Stress

Extreme fatigue, emotional stress, severe infections, severe pain, traumatic injury, and illegal drug use can trigger A-Fib. Low or high blood and tissue concentrations of minerals such as potassium, magnesium and calcium can trigger A-Fib. Thyroid problems (hyperthyroidism), lung disease, reactive hypoglycemia, obesity, viral infections, diabetes, and smoking can trigger A-Fib. Smoking reduces the ability of the blood to carry oxygen (anemic hypoxia). Smoking cigarettes raises the risk of developing A-Fib even if one stops smoking, possibly because past smoking leaves behind permanent fibrotic damage to the atrium which makes later A-Fib more likely. 12  

Being Overweight

As we put on pounds, our risk of developing A-Fib increases. In recent studies overweight adults were 39% more likely, and obese adults 87% more likely, to develop A-Fib than their normal-weight counterparts. 13

Health problems linked to obesity, like high blood pressure and diabetes, can contribute to A-Fib. And obesity may put extra pressure on the pulmonary veins and induce A-Fib. Left atrial hypertension is a common finding in obese patients.

Genetics

Some research has identified a Familial A-Fib where A-Fib is passed on genetically 14 . (Editor’s Theory: Some consider all A-Fib genetic in that we are born with A-Fib triggers—usually the Pulmonary Vein Openings in the Left Atrium. They seem to be genetically related to and similar in structure to the AV Node, the natural pacemaker of the heart. They usually beat in sync with the AV Node. But when impaired, they start beating on their own producing A-Fib signals. But be advised that this is only a theory and not established medical fact.)

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A-FIB TRIGGERS

Some cases have been reported where antihistamines, bronchial inhalants, local anesthetics, medications such as sumatriptan, a headache drug, 15 tobacco use, MSG, cold beverages and eating ice cream, high altitude, and even sleeping on one’s left side or stomach are said to have triggered A-Fib. The author used to include caffeine (coffee, tea, sodas, etc.) in this list, but some research suggests that coffee and caffeine in moderate to heavy doses (2-3 cups to 10 cups/day) may not trigger or induce A-Fib. 16

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Coffee (caffeine) may indeed be antiarrhythmic and may reduce propensity and inducibility of A-Fib both in normal hearts and in those with focal forms of A-Fib. 17 to Karl for calling our attention to these articles.)

Chocolate in large amounts may trigger attacks. Chocolate contains a little caffeine, but also contains the structurally related theobromine, a milder cardiac stimulant (thanks to Prof. Phil Page from the UK for this info). GERD (heartburn) and other stomach problems (like H. pylori) may be related to or trigger A-Fib. If so, antacids and proton pump inhibitors like Nexium may help your A-Fib (Thanks to Ian Betts for this observation). A report from England suggests that the veterinary antibiotic “Lasalocid” found in eggs and poultry meat may cause or trigger A-Fib. 18 One person writes that hair regrowth products seem to trigger his A-Fib. Another writes that the natural sweetener and sugar substitute Stevia seems to trigger her A-Fib.

Sleep Apnea

Recent research indicates sleep apnea (where your breathing stops while you are sleeping) may contribute to A-Fib, probably by causing stress on the Pulmonary Vein openings and/or by depriving the lungs and body of adequate oxygen supply (Hypoxemic Hypoxia). Many people have sleep apnea and don’t know it. Your significant other can tell you if you snore a lot, which is often a sign of sleep apnea. If you have A-Fib, it might be wise to have yourself checked for sleep apnea.  (Thanks to David Embler and Warren Stuart for these observations.)

A Pulse Oximeter, available in drug stores, can give you a “quick” diagnosis of how much oxygen is in your blood. Below 90% would indicate you need to have a sleep lab study. (Thanks to Rose Vernier for this info.)

(Gail writes that both her sleep apnea and her A-Fib were cured by a CPAP [Continuous Positive Airway Pressure] breathing machine. E-mail: gail(at)bonairwine.com.

Mechanically Induced A-Fib

Be careful if you work around equipment that vibrates. Certain frequencies and/or vibrations may possibly trigger or induce A-Fib. (If anyone has any info on how or why high frequencies and/or vibrations may possibly affect A-Fib, please let me know.)

Jerry writes that high powered magnets, such as the N50, may trigger A-Fib due to the electromagnetic fields they generate. (If anyone has any info on this, please email me.)

Physical and Gender Characteristics

Athletes are more prone to A-Fib perhaps because they have larger hearts where there is more room for these extra electrical signals to develop and propagate, and possibly because of the extra pressure they put on their pulmonary veins through aerobic exercise. A-Fib is often found in tall people, particularly basketball players. 19 Men get A-Fib more than women.

Aging

A-Fib is associated with aging of the heart. As patients get older, the prevalence of A-Fib increases, roughly doubling with each decade. 2-3% of people in their 60s, 5-6% of people in their 70s, and 8-10% of people in their 80s have A-Fib. 20 , 21 , 22 Approximately 70% of people with A-Fib are between 65 and 85 years of age. 23  This suggests that A-Fib may be related to degenerative, age-related changes in the heart. Inflammation may contribute to the structural remodeling associated with A-Fib. 24

No Known Cause

But in many A-Fib cases (around 50% of Paroxysmal A-Fib 25 ), there is no currently discernible cause or trigger (called “Lone” or “Idiopathic A-Fib”). 26 (Some research suggests that inflammation may initiate Lone A-Fib. 27

♦♦♦

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Last updated: Sunday, November 9, 2014

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References    (↵ returns to text)
  1. Miyasaka, Yoko, et al, Secular Trends in Incidence of Atrial Fibrillation in Olmsted County, Minnesota, 1980 to 2000, and Implications on the Projections for Future Prevalence Circulation, 2006;114:119-125. Last accessed Feb 15, 2013. URL: http://www.circ.ahajournals.org/cgi/content/full/114/2/119
  2. Nelson, Bryn. “Places In The Heart,” NYU Physician. Spring, 2009, p. 8.
  3. Van Wagoner, David “Atrial selective strategies for treating atrial fibrillation.” Drug Discovery Today: Therapeutic Strategies Vol 2, No. 3, 2005. “We have detected increased levels of the systemic inflammatory marker C-reactive protein (CRP) in patients with A-Fib.”
  4. “When the heart gets out of step – Newly identified gene may open route to innovative treatments for atrial fibrillation…” Ludwig-Maximilians-Universitat Munchen, 02/21/2010.
    http://www.disabled-world.com/health/cardiovascular/irregular-heartbeat.ph
  5. Camm, “Stroke in atrial fibrillation: Update on pathology, new antithrombotic therapies, and evolution of procedures and devices.” Annals of Medicine, 39:5, 371-391, 2007
  6. The Link Between Infections and Inflammation in Heart Disease. Life Extension Vitamins. Last accessed November 5, 2012 http://www.lifeextensionvitamins.com/cadico6otco.html
  7. Frost L., et al. “Atrial fibrillation and flutter after coronary artery bypass surgery: epidemiology, risk factors and preventive trials. International Journal of Cardiology. 1992;36:253-262.
  8. Bottom Line Personal, October 15, 2014, p. 11. Kallmunzer, Bernd et al. Peripheral pulse measurement after ischemic stroke. Nuerology, Published Online May 6, 2014 http://www.neurology.org/content/83/7/598.abstract?sid=f532228b-5314-46d3-bdca-a7db9bc7fa7d
  9. Calkins, H. and Berger, R. “Atrial Fibrillation The Latest Management Strategies.” The Johns Hopkins Medicine Library, p. 10.
  10. http://www.newswise.com/articles/alcohol-may-trigger-serious-palpitations-in-heart-patients
  11. Conen D, Tedrow UB, Cook NR, Moorthy MV, Buring JE, Albert CM (December 2008). “Alcohol consumption and risk of incident atrial fibrillation in women”. JAMA 300 (21): 2489 96.
    doi:10.1001/jama.2008.755. PMID 19050192. PMC 2630715. http://jama.ama-assn.org/cgi/content/full/300/21/2489.
  12. Heeringa J, et al. Cigarette smoking and risk of atrial fibrillation: the Rotterdam Study. Am Heart J. 2008 Dec;156(6):1163-9. doi: 10.1016/j.ahj.2008.08.003. Last accessed Jan 6, 2013 URL: http://www.ncbi.nlm.nih.gov/pubmed/19033014
  13. Vivek Y. Reddy, M.D., Joins The Mount Sinai Medical Center as Director of Electrophysiology Laboratories.  May 6, 2009 . http://www.prweb.com/printer/2396634.htm
  14. Brugada R. “Identification of a genetic locus for familial atrial fibrillation,” New England Journal of Medicine 1997;336:p. 905-911. Ellinor et al., 2005, 2008. Sinner et al., 2011.
  15. The Link Between Infections and Inflammation in Heart Disease. Life Extension Vitamins. Last accessed November 5, 2012 http://www.lifeextensionvitamins.com/cadico6otco.html
  16. Katan, M, Schouten, E. Caffeine and arrhythmia1,2,3. Am J Clin Nutr March 2005 vol. 81 no. 3 539-540. Last accessed November 5, 2012 http://www.ajcn.org/cgi/content/full/81/3/539
  17. Rashid, Abdul et al. “The effects of caffeine on the inducibility of Atrial fibrillation.” J Electrocardiol. 2006 October, 39(4): 421-425. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2257921
  18. Barclay, L. Caffeine Not Associated With Increased Risk of Atrial Fibrillation. Mar 10, 2005. Medscape News Today. Last accessed November 5, 2012. http://www.medscape.com/viewarticle/501279?src=search
  19. “The tallest patients in a recent study were 32% more likely to have A-Fib than the shortest ones. Doctors estimate that for every six-inch increase in height, the risk for A-Fib increases by 50%.” Bottom Line Health, July, 2006, p. 14.
  20. Go, “Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) study. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention.” JAMA, 2001:285:2370-2375.
  21. Philip A. et al. Atrial Fibrillation: A Major Contributor to Stroke in the Elderly, : The Framingham Study. Arch Intern Med 1987;147:1561-1564.
  22. Feinberg, “Prevalence, age distribution, and gender of patients with atrial fibrillation: analysis and implications.” Arch Intern Med 1995;155:469-473.
  23. Laish-Farkash, A. et al. Atrial Fibrillation in the Elderly—To Ablate or Not to Ablate, J Cardiovasc Electrophysiol. 2013;24(7):739-741. http://www.medscape.com/viewarticle/807303.
  24. Van Wagoner, David “Atrial selective strategies for treating atrial fibrillation.” Drug Discovery Today: Therapeutic Strategies Vol 2, No. 3, 2005. “We have detected increased levels of the systemic inflammatory marker C-reactive protein (CRP) in patients with A-Fib.
  25. Allessie, Maurits A. et al. “Pathophysiology and Prevention of Atrial Fibrillation.” Circulation. 2001;103:769.
  26. Ibid.
  27. Ibid.

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