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What is atrial fibrillation?

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Atrial fibrillation, often called AFib or AF, is the most common type of treated heart arrhythmia. An arrhythmia is when the heart beats too slowly, too fast, or in an irregular way.

When a person has AFib, the normal beating in the upper chambers of the heart (the two atria) is irregular, and blood doesn’t flow as well as it should from the atria to the lower chambers of the heart (the two ventricles). AFib may happen in brief episodes, or it may be a permanent condition.

What are the symptoms of AFib?
Some people who have AFib don’t know they have it and don’t have any symptoms. Others may experience one or more of the following symptoms: irregular heartbeat; heart palpitations (rapid, fluttering, or pounding); lightheadedness; extreme fatigue; shortness of breath; and chest pain.

What are the risk factors for AFib?
The risk for AFib increases with age. High blood pressure, the risk for which also increases with advancing age, accounts for about one in five cases of AFib.

Risk factors for AFib include: advancing age; high blood pressure; obesity; European ancestry; diabetes; heart failure; ischemic heart disease; hyperthyroidism; chronic kidney disease; moderate to heavy alcohol use; smoking; and enlargement of the chambers on the left side of the heart.

How is AFib related to stroke?
AFib increases a person’s risk for stroke. When standard stroke risk factors were accounted for, AFib was associated with a four- to fivefold increased risk of ischemic stroke. AFib causes about one in seven strokes.

Strokes caused by complications from AFib tend to be more severe than strokes with other underlying causes. Strokes happen when blood flow to the brain is blocked by a blood clot or by fatty deposits called plaque in the blood vessel lining.

How is AFib treated?
Treatment for AFib can include: medicines to control the heart’s rhythm and rate; blood-thinning medicine to prevent blood clots from forming and reduce stroke risk; surgery; and medicine and healthy lifestyle changes to manage AFib risk factors.

Prevention
To prevent atrial fibrillation, it’s important to live a heart-healthy lifestyle to reduce your risk of heart disease. A healthy lifestyle may include: eating a heart-healthy diet; increasing your physical activity; avoiding smoking; maintaining a healthy weight; limiting or avoiding caffeine and alcohol; reducing stress, as intense stress and anger can cause heart rhythm problems; and using over-the-counter medications with caution, as some cold and cough medications contain stimulants that may trigger a rapid heartbeat.

Weight loss, routine exercise can ease Afib management
Not enough Americans with atrial fibrillation, or Afib, are using weight loss and routine exercise regimens to manage the condition, according to the American Hearth Association.

In a scientific statement published in Circulation, the AHA noted that attaining and maintaining a healthy body weight and getting regular, moderate physical activity are useful additions to physician-guided prescription drug treatment for Afib, a heart rhythm abnormality that can lead to stroke.

Quitting smoking and reduced alcohol intake can also help, as can screening for and treating sleep apnea, the group said.

“While established medical treatment protocols remain essential, helping atrial fibrillation patients adopt healthier lifestyle habits whenever possible may further help to reduce episodes of atrial fibrillation,” Mina K. Chung, chair of the AHA writing group for the scientific statement and a cardiologist and professor of medicine at the Cleveland Clinic, said in a statement.

Afib affects at least 2.7 million people in the United States and is increasing, as the population grows older, the organisation said.

In people with the condition, the upper chambers of the heart, the atria, beat rapidly and erratically, interfering with proper movement of blood, which can cause clots to form and potentially lead to stroke.

People with Afib have a five-fold greater risk of having a stroke compared to people without the condition, the AHA noted. To reduce this risk, people with the condition typically take prescription drugs or undergo surgical procedures designed to regulate their heart rate, prevent abnormal heart rhythms and reduce blood clotting.

According to the AHA, obesity can contribute to enlargement and stretching of the heart’s upper chambers, changing the way the chambers work and making Afib more likely to occur and to be persistent rather than occasional. In an Australian study, people who were overweight or had obesity and lost at least 10 percent of their body weight were less likely to develop Afib or to have it become persistent.

In addition, obesity is often associated with sleep apnea, a type of disordered breathing that raises risk for Afib.

Regular, moderate physical activity can help people attain and maintain a healthy weight, without increasing their risk for Afib — and can also help to prevent and treat the condition.

However, the scientific statement notes that extreme levels of physical activity, such as that of endurance athletes and professional football players, may raise the risk of Afib.

“To help patients make healthy lifestyle changes, we suggest setting specific, progressive achievable weight and exercise targets, and prescribing lifestyle intervention programs that can provide appropriate supports,” Chung said. “Using a pedometer, smartphone/watch apps or other wearable devices that provide activity feedback, as well as apps that help people track food intake, can be helpful to keep people motivated.”

Smoking and alcohol consumption can also increase risk for Afib, researchers point out in the statement.

Smoking not only raises the risk for Afib, it reduces the efficacy of treatment for a condition called ablation, a procedure to destroy cells that generate abnormal rhythms.

Moderate or high alcohol use — more than seven drinks per week in women and 14 per week in men — raises risk for Afib, with a recent study showing that reducing or abstaining from alcohol can improve heart rhythm control.

Overall, though, the scientific evidence on lifestyle and Afib is limited because the studies on the subject are mostly observational, which can identify links but cannot prove cause and effect.

“In particular, we need further work on the effects of high intensity and other physical activities, and studies on the need for and effects of screening and treating sleep apnea for atrial fibrillation,” Chung said. “However, the data emerging support the beneficial effects of lifestyle modification to reduce atrial fibrillation and are a call to action to develop and utilize integrated, multidisciplinary teams and/or structured programs that can facilitate intensive and comprehensive lifestyle counseling for our patients.”

*Dr. Anthony Nwaoney is an epidemiologist


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