6 Steps to Manage or Prevent AFib?>

6 Steps to Manage or Prevent AFib

by Tim Gower

If you have atrial fibrillation (AFib), making a few changes to your daily routine could be useful in the management of the condition, which causes the heart to beat erratically and puts you at increased risk for a stroke or heart failure. AFib is typically managed with medication and, when needed, certain medical procedures. Growing evidence suggests that integrating lifestyle changes into an AFib treatment plan can further reduce episodes of AFib. What’s more, making such lifestyle changes can prevent AFib from emerging in the first place.

In March 2020, the American Heart Association (AHA) published a scientific statement in the journal Circulation that emphasizes the importance of modifying risk factors for controlling, as well as preventing, AFib. The AHA statement recommends taking the following steps to manage or guard against AFib.

What Is Atrial Fibrillation (AFib)?

Atrial fibrillation (AFib), which causes an irregular and often rapid heart rate, is the most common form of cardiac arrhythmia and a leading cause of strokes. There are four main types of AFib.

1. Manage your weight

Obesity is a significant risk factor for developing AFib and makes the condition harder to control if you have it. People who are obese have a body mass index (BMI, a standard measurement of body fat) of 30or higher. However, even carrying a few extra pounds seems to make you more vulnerable to irregular heartbeats, with some studies suggesting an increased risk among people classified as overweight (a BMI between 25 and 29.9). For example, the long-running Framingham Heart Study found that each one-unit increase in BMI was associated with a 4 percent increase in AFib risk among its participants.

If you’re overweight or obese, shedding some pounds can help prevent AFib episodes, according to several studies. In one study, published in 2015 by the Journal of the American College of Cardiology, people with AFib who participated in a structured weight-loss program were more likely to keep the weight off than those who didn’t participate in a program.

Work with your doctor or a registered dietitian to develop a low-calorie diet you can stick with if you need to lose weight. If you’re severely obese (a BMI of 35 or higher), you may be a candidate for bariatric (weight-loss) surgery, which appears to reduce the risk for AFib.

2. Get moving

Research suggests that boosting your physical activity level is associated with a reduced risk of AFib episodes and that being sedentary is an independent risk factor for AFib. If you don’t currently exercise, daily activity (especially when accompanied by weight loss if you’re overweight or obese) is likely to help prevent AFib or ease its burden, some studies suggest.

For example, in a Swedish study published in the journal Heart in 2015, researchers asked more than 36,500 women (ages 49 to 83 at the study’s start) to periodically report their level of routine physical activity over 12 years. At the end of the study, the researchers found that regular exercisers had a modest but significantly lower risk for developing AFib. For instance, women who walked or bicycled for at least 40 minutes a day were 19 percent less likely to have AFib than others who rarely or never did.

How much exercise is right for you? The AHA advises following the Physical Activity Guidelines for Americans, which includes getting at least 150 minutes a week (or about a half-hour most days) of moderately intense aerobic exercise to improve cardiovascular health.

Aerobic exercise includes any activity that increases your heart rate and that you can perform for a sustained period. Along with walking and bicycling, other moderately intense activities include swimming, dancing, some forms of housework (like washing windows or floors), and gardening. If you prefer more vigorous forms of physical activity, aim for 75 minutes or more of higher intensity exercise such as jogging or playing tennis.

According to the AHA’s statement, mind-body exercises like yoga and tai chi might help control AFib, too. Such practices combine movement, mental focus, and controlled breathing to build strength, balance, and flexibility, as well as calm the mind. That’s important because increased activity in the body’s sympathetic nervous system—which governs your “fight-or-flight” response when you feel stressed or anxious—often precedes AFib episodes.

3. Treat sleep-disordered breathing

Many people with AFib also have obstructive sleep apnea or other related sleep disorders that interfere with normal breathing during slumber. Research suggests that the two conditions may share an underlying physiological cause, since people with severe sleep apnea symptoms have a particularly high risk for AFib. And their AFib often doesn’t respond well to drug therapy.

While more studies are needed to confirm a link between AFib and sleep apnea, some investigations (though not all) have found that treating the latter can help decrease the frequency of AFib episodes. Some evidence suggests that patients with both conditions who received treatment for sleep apnea with continuous positive airway pressure (CPAP) devices—which use gentle air pressure to keep airways open while you sleep—had fewer recurrences of AFib symptoms.

The AHA statement recommends that people who have AFib be screened for sleep apnea. It also suggests that people who are obese or overweight be screened for sleep disorders. Losing weight can decrease the severity of sleep apnea.

Symptoms of AFib

Symptoms of atrial fibrillation (AFib) can vary from person to person, and some people who develop the condition won’t experience symptoms at all. Here are some of the most common ones.

4. Control diabetes

Type 2 diabetes has been associated with AFib in several large studies. The Framingham Heart Study found that men and women with diabetes had a 40 percent and 60 percent increased risk for AFib, respectively.

Several large studies suggest that keeping diabetes under control with oral medications could help keep AFib at bay. However, doctors haven’t yet established just how aggressive blood sugar control should be to make a difference when it comes to the risk of developing AFib; more research in that area is needed.

5. Lower high blood pressure

A study published in Circulation in 2011 that involved nearly 15,000 middle-aged men and women found that elevated blood pressure was the single biggest risk factor for developing AFib—and that more than half of all AFib cases are potentially avoidable by lowering high blood pressure and other cardiovascular risk factors.

You can lower high blood pressure—also a risk factor for stroke—with a combination of a nutritious diet, including limiting salt intake, and the same lifestyle changes that reduce AFib risk, such as engaging in regular physical activity and losing excess weight. The AHA recommends a blood pressure target of less than 120/80 mm Hg. If your blood pressure remains high despite lifestyle changes, your doctor may prescribe one or more antihypertensive drugs.

6. Don’t smoke, and limit alcohol

Smokers are more likely than nonsmokers to develop AFib, though experts don’t completely understand why that’s the case. However, if you use tobacco and still need a reason to quit, consider this: If you have AFib and medications don’t relieve your symptoms, a procedure called catheter ablation (which uses different forms of energy to destroy heart tissue that promotes irregular heartbeats) can help—but it’s less effective in smokers.

Exceeding seven alcoholic drinks a week in women and 14 drinks a week in men is associated with an increased risk for AFib. If you drink, cutting back or abstaining appears to lower that risk. In a study published in January 2020 in the New England Journal of Medicine, researchers asked 70 AFib patients who were regular alcohol users to abstain for six months.

Over that time, roughly half (53 percent) had an AFib recurrence, while nearly three-quarters (73 percent) of nonabstainers in a comparison group experienced an episode of AFib.

This article first appeared in the August 2020 issue of UC Berkeley Health After 50.

Also see Atrial Fibrillation, Anticoagulants, and Dementia.