"This book is incredibly complete and easy-to-understand for anybody. I certainly recommend it for patients who want to know more about atrial fibrillation than what they will learn from doctors...."

Pierre Jaïs, M.D. Professor of Cardiology, Haut-Lévêque Hospital, Bordeaux, France

"Dear Steve, I saw a patient this morning with your book [in hand] and highlights throughout. She loves it and finds it very useful to help her in dealing with atrial fibrillation."

Dr. Wilber Su Cavanaugh Heart Center, Phoenix, AZ

"Your book [Beat Your A-Fib] is the quintessential most important guide not only for the individual experiencing atrial fibrillation and his family, but also for primary physicians, and cardiologists."

Jane-Alexandra Krehbiel, nurse, blogger and author "Rational Preparedness: A Primer to Preparedness"


"Steve Ryan's summaries of the Boston A-Fib Symposium are terrific. Steve has the ability to synthesize and communicate accurately in clear and simple terms the essence of complex subjects. This is an exceptional skill and a great service to patients with atrial fibrillation."

Dr. Jeremy Ruskin of Mass. General Hospital and Harvard Medical School

"I love your [A-fib.com] website, Patti and Steve! An excellent resource for anybody seeking credible science on atrial fibrillation plus compelling real-life stories from others living with A-Fib. Congratulations…"

Carolyn Thomas, blogger and heart attack survivor; MyHeartSisters.org

"Steve, your website was so helpful. Thank you! After two ablations I am now A-fib free. You are a great help to a lot of people, keep up the good work."

Terry Traver, former A-Fib patient

"If you want to do some research on AF go to A-Fib.com by Steve Ryan, this site was a big help to me, and helped me be free of AF."

Roy Salmon Patient, A-Fib Free; pacemakerclub.com, Sept. 2013


Fall and Winter Warning: Fireplace Use May Trigger A-Fib

Fall and Winter brings use of many a fireplace and a reminder for those with A-Fib. The tiny particles generated when you burn wood can inflame and damage blood vessels and may trigger arrhythmias, according to Dr. Robert A. Kloner. If you have A-Fib you may want to avoid wood-burning fireplaces and stoves.

In general you may want to also avoid campfires, bonfires, trash or leaf burning, etc.

If you live in communities with a lot of wood-burning stoves, you may want to use a HEPA air purifier in your home. If you are a guest and can’t avoid a wood-burning fireplace, sit as far away as possible or wear a face mask like your dentist wears (mine gave me a bunch for free). If you have a fireplace, consider installing an electric or other non-wood burning insert.

Reference: Kloner, Robert A. ‘Tis the Season…For Heart Attacks. Bottom Line Health, Volume 28, Number 12, December 2014.

FAQs Understanding A-Fib: Local Anesthesia Can Trigger A-Fib

 FAQs Understanding A-Fib: Local anesthesia

FAQs Understanding Your A-Fib A-Fib.com12. “I read that the local anesthesia my dentist uses may trigger my A-Fib. Why is that? What can I do about it?”

Dr. Sam, a retired MD, wrote to caution A-Fib patients that local anesthesia containing epinephrine can trigger your A-Fib. Local anesthesia (with Epi or Adrenalin) is used by dentists and emergency room personnel.

Dr. Sam writes:

At the Dentist: “This past year I had to have a dental implant and bridgework requiring that I have Local Anesthesia several times. The dentist uses local anesthesia with Epinephrine (Epi or Adrenalin) to numb your mouth.

Epinephrine (Epi or Adrenalin) is one of the drugs EPs can use when completing a catheter ablation—they try to trigger A-Fib to check that their ablation scars for working.  So dental local anesthesia with Epinephrine (Epi) potentially can trigger A-Fib. I found very little info online about this and no studies had been done about dental anesthesia with Epi & A-Fib.

My EP said he thought it would be OK to use. So I had it, and within 30 minutes I was in A-Fib which lasted about 20 minutes and then I went back into NSR.

From then on I requested my dentist use only local anesthesia without Epi, and I had no more A-Fib episodes. Dentists like to use local anesthesia with Epi because it lasts longer and reduces bleeding locally.

Discuss with your dentist if you think you’re sensitive. Tell him/her you have A-Fib.”

At the Opthamologist: “The drops that the eye doctor uses to dilate your eyes are similar to Adrenalin.  Discuss with your eye doctor if you think you’re sensitive. Tell him/her you have A-Fib.”

At the Emergency Room:In the ER doctors use local anesthesia with Epi to sew up lacerations and/or to do small surgical procedures requiring local anesthesia, because it reduces bleeding locally and lasts longer. Tell your doctor you have A-Fib and discuss your concern that the use of local anesthesia with Epi may trigger your Atrial Fibrillation.”

Thanks Dr. Sam for sharing this warning about Epinephrine containing products.

Go back to FAQ Understanding A-Fib

FAQs from Newly Diagnosed Patient

You are not alone. A-Fib.comFrequently Asked Questions by Newly Diagnosed Patients

Newly diagnosed Atrial Fibrillation patients have many questions about living with A-Fib. These are answers to the most frequently asked questions by patients and their families. (Click on the question to jump to the answer)

1.  My doctor says I had an attack of A-Fib. How much trouble am I in?

2.  Did I cause my Atrial Fibrillation? Am I responsible for getting A-Fib?

3.  “Could my A-Fib go away on its own? I don’t want to take any medication. Can I just wait and see?”

4.  “Is Atrial Fibrillation a prelude to a heart attack?

5.  “Can I die from my Atrial Fibrillation? Is it life threatening?”

6.  “Is Atrial Fibrillation curable? Or can you only treat or control it? Should I seek a cure?

7.  “Is there a diet I could follow which would cure my A-Fib?

8.  “Should I cool my sex life? Can I exercise if I have Atrial Fibrillation? Should I exercise?

9.  “I have a lot of stress at work. Does this stress cause or trigger my A-Fib?”

10. “Can I drive my car if I have Atrial Fibrillation?

11. “Is drinking coffee (tea, colas, other products with caffeine) going to make my A-Fib worse or trigger an A-Fib attack?

12. “Is there anything I can do to get out of an A-Fib episode? How do others deal with their episodes?

13. “Should I carry a wallet card or a medical ID? I have A-Fib and take Coumadin. In case of an A-Fib emergency, what information should I include?

14. “I live in fear of my A-Fib. I never know when I’m going to get an A-Fib attack or how long it will last. How do I deal with the anxiety? 

15. “Should I see a cardiologist for my A-Fib and not just my primary care doctor? He wants to prescribe medication. Should I also see a specialist?”

Last updated: Monday, July 13, 2015

Return to Frequently Asked Questions

FAQs Coping with A-Fib: Predicting Attacks

FAQs Coping with A-Fib: Predicting Attacks

FAQs A-Fib afib2. Is there any way to predict when I’m going to have an A-Fib attack?”

Try being a private detective! Start by keeping a log or diary of your A-Fib episodes for three or six months. Then analyze your log for patterns.

By studying your log you may find, for example, that your A-Fib episodes come mostly at night, or after a meal which may mean you have Vagal A-Fib. What is the interval between your A-Fib episodes? Some people have very regular intervals between A-Fib attacks. A-Fib Support Volunteer, Max, for example, had regular A-Fib episodes every morning at 7am. (Read Max’s A-Fib story #43: A-Fib Causes Devastating Effects—From Shanghai to Bordeaux..) Knowing these patterns may help you deal with your A-Fib.

But not every log will be revealing. A-Fib seems to have a mind and schedule of its own that’s often hard to predict.

When I had A-Fib, I had little success predicting attacks. I had very short episodes no longer than five minutes often during the day. I was never able to predict when they would occur, or identify what may have triggered them.

Back to FAQs: Coping with Your A-Fib

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 


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.


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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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.


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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