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. Each year there are over 340,000 new cases in the US. A-Fib is the most common heart arrhythmia. In the U.S. people over 40 have a one-in-four lifetime risk of developing A-Fib.

Worldwide the number of cases is estimated to be 33.5 million or 0.5% of the world’s population. A-Fib has rightly been called an emerging epidemic.

Risk Factors: HOW DO YOU GET A-FIB?

(The “causes” or more properly “risk factors” discussed below doesn’t necessarily mean that a risk factor such as high blood pressure caused or is responsible for your A-Fib. There could be many other factors at play here. People with high blood pressure, for example, don’t automatically or inevitably develop 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 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. Hypertension is high among people with A-Fib, about 70% to 90% based on randomized clinical trials of DOACs (Direct Oral Anticoagulants).

About 25% to 35% of stroke survivors experience atrial fibrillation; Up to 40% of patients 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. (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. (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 A-Fib.

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 (hypothyroidism), lung disease, reactive hypoglycemia, viral infections and diabetes.

Extreme fatigue, anxiety and emotional stress can trigger A-Fib. (Even “minor” stress may trigger A-Fib. Harlan writes that something as simple as watching an emotional or scary movie or TV show may trigger his 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.

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.

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

Research has identified a Familial A-Fib where A-Fib is passed on genetically. 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.

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, tobacco use, MSG, cold beverages and eating ice cream, high altitude, dehydration, eating a large meal, 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. Coffee (caffeine) may indeed be antiarrhythmic and may reduce the propensity and inducibility of A-Fib both in normal hearts and in those with focal forms of A-Fib.

But we are all different. If coffee triggers your A-Fib, consider switching to decaf.

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.

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).

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.) 

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 $30 from Amazon.com and in drug stores. A reading below 90% would indicate you need to have a sleep lab study.

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.)

To learn more, see Sleep Apnea: When Snoring Can Be Lethal and Sleep Apnea: Home Testing with WatchPAT Device and the Philips Respironics

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 email me.) Don Thompson describes how working on an oil drilling rig with a vibrating plate “a shaker” caused him to go into A-Fib. See Don Thompson Story.

Isabel Pichardo writes that the vibrations from riding in her husband’s Mini Cooper trigger her A-Fib for long periods.

Michael writes, “I had an A-Fib attack right after using a tens device on my shoulder close to my heart. I’m sure this set it off. Within 30 minutes after the tens treatment, I was in A-Fib. I was feeling very well with no stress. It had been 10 years since my last A-Fib attack.”

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

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.

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. Approximately 70% of people with A-Fib are between 65 and 85 years of age.

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.

No Known Cause

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

Explore Treatments for A-Fib

Regardless of the cause of your A-Fib, we make it easy to explore the various treatments for Atrial Fibrillation. Both short-term and long-term approaches aim to control or eliminate the abnormal heart rhythm associated with A-Fib. Go to Treatments.

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If you find any errors on this page, email us. Y Last updated: Wednesday, December 30, 2020