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What Causes Atrial Fibrillation?

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

Causes of Atrial Fibrillation

What are the Causes of A-Fib?

It’s estimated as many as 5.1 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 33.5 million or 0.5% of the world’s population.4 A-Fib has rightly been called an emerging 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 obesity6 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.

About 25% to 35% of stroke survivors experience atrial fibrillation;7 Up to 40% of patients8 get A-Fib after open heart surgery. “Pericarditis”—inflammation of the pericardium, a sack-like membrane surrounding the heart—can lead to A-Fib. 

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.])

See the personal A-Fib story by Kris: “Binge Drinking Leads to Chronic A-Fib, Amiodarone Damages Eyesight” pp. 144-150 in my book, Beat Your A-Fib.

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

Severe infections, severe pain, traumatic injury, and illegal drug use can be a trigger. 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, viral infections and diabetes.

To learn the impact of anxiety and emotional stress on A-Fib, see Jay Teresi’s personal story “Anxiety the Greatest Challenge

Extreme fatigue, anxiety and emotional stress can trigger A-Fib.

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

See the personal story and VIDEO by Susan Klein: My Family’s A-Fib was Misdiagnosed for Years.

Research has identified a Familial A-Fib where A-Fib is passed on genetically14  Do you have a parent or other immediate family member with A-Fib? Research says you have a 40% increased risk of developing A-Fib yourself. And the younger that family member was when they got A-Fib, the more likely you are to develop A-Fib.

According to Dr. Dan Roden of Vanderbilt University, genetic research may become important to A-Fib patients. He postulates that “Lone A-Fib” (A-Fib without a known cause) may actually be caused by genetics.

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A-FIB TRIGGERS

We’ve had reports that A-Fib can be triggered by 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. One person writes that hair regrowth products seem to trigger his A-Fib.

I 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 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

From the publisher of A-Fib.com: 'Beat Your A-Fib: The Essential Guide to Finding Your Cure' by Steve S. Ryan, PhD; Click to order your copy Today!

From the publisher of A-Fib.com

Possible Food-Related Triggers

Chocolate in large amounts may trigger attacks. Chocolate contains a little caffeine, but also contains the structurally related theobromine, a milder cardiac stimulant.

Another reader writes that the natural sweetener and sugar substitute Stevia seems to trigger her A-Fib.

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. A report from England suggests that the veterinary antibiotic “Lasalocid” found in eggs and poultry meat may cause or trigger A-Fib.18

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).

Over 25 million Americans currently have sleep apnea, but 80% of these people don’t know they have it

In one study of patients with A-Fib, 43% had sleep apnea. (An additional 31% had “central sleep apnea/Cheyne-Stokes respiration” which is a different type of sleep apnea.)19  

If you have A-Fib, it’s wise to have yourself checked for sleep apnea. You can do a “quick” check of how much oxygen is in your blood with a Pulse Oximeter, such as the Contec Pulse Oximeter for about $20 from Amazon.com and in drug stores. A reading below 90% would indicate you need to have a sleep lab study.

You may want to check out the web site, MySleepApnea, http://www.myapnea.org, an online community for people with sleep apnea to s hare health info and personal experiences. (The Shaquille O’Neal video is terrific!)

Gail writes that “both her sleep apnea and her A-Fib were cured by a CPAP [Continuous Positive Airway Pressure] breathing machine.” (E-mail her: 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 you have any info on this, please email me.)

Physical and Gender Characteristics

Men get A-Fib more than women. But women may have more symptoms.

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.20

Men get A-Fib more than women. But women fail more antiarrhythmic drugs therapies than men and may have more symptoms. For more see my article: The Facts About Women with A-Fib: Mother Nature and Gender Bias.

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.21,22,23Approximately 70% of people with A-Fib are between 65 and 85 years of age.24 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.25

No Known Cause

But in many A-Fib cases (around 50% of Paroxysmal A-Fib26), there is no currently discernible cause or trigger (called “Lone” or “Idiopathic A-Fib”).27 (Some research suggests that inflammation may initiate Lone A-Fib.)28

Read how others have dealt with their Atrial Fibrillation at A-Fib.com

Visit http://a-fib.com/personal-experiences/

Last updated: Sunday, April 10, 2016

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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. S. S. Chugh, et al. Worldwide Epidemiology of Atrial Fibrillation: A Global Burden of Disease 2010 Study. Circulation, 2013; DOI: 10.1161/CIRCULATIONAHA.113.005119
  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. 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
  8. 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.
  9. Calkins, H. and Berger, R. “Atrial Fibrillation The Latest Management Strategies.” The Johns Hopkins Medicine Library, p. 10.
  10. Alcohol May Trigger Serious Palpitations in Heart Patients. American Journal of Cardiology (August 1, 2012) 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.ncbi.nlm.nih.gov/pmc/articles/PMC2257921/
  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. Bitter, T. et al. Sleep-disordered Breathing in Patients With Atrial Fibrillation and Normal Systolic Left Ventricular Function. Dtsch Arztebl Int 2009; 106(10): 164-70  http://www.aerzteblatt.de/pdf/di/106/10/m164.pdf. DOI: 10.3238/arztebl.2009.0164
  20. “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.
  21. 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.
  22. Philip A. et al. Atrial Fibrillation: A Major Contributor to Stroke in the Elderly, : The Framingham Study. Arch Intern Med 1987;147:1561-1564.
  23. Feinberg, “Prevalence, age distribution, and gender of patients with atrial fibrillation: analysis and implications.” Arch Intern Med 1995;155:469-473.
  24. 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.
  25. 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.
  26. Allessie, Maurits A. et al. “Pathophysiology and Prevention of Atrial Fibrillation.” Circulation. 2001;103:769.
  27. Ibid.
  28. Ibid.

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