Is Atrial Fibrillation a Lifestyle Disease?

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We have known for a long time that atrial fibrillation can be caused by numerous medical problems, including heart disease (such as coronary artery disease, mitral regurgitation, and pericarditis), thyroid disease, hypertension, sleep apnea, various lung problems, such as pneumonia or pulmonary embolism, and (for some people) drinking alcohol. Even so, in the large majority of people who have atrial fibrillation, no particular underlying cause has been identifiable.

Doctors have traditionally told these people they have “idiopathic” atrial fibrillation, which is to say, there is no apparent reason for it; it’s just one of those curveballs life throws at you.

But recent studies have revealed that there is indeed an underlying cause for most people who have atrial fibrillation—poor lifestyle choices, in particular, being overweight and sedentary.

Lifestyle and Atrial Fibrillation

We have known for a long time that there is an association between being overweight and out of shape, and having atrial fibrillation. But in the past few years it has become apparent that it’s more than just an association—it’s a cause-and-effect relationship.

Researchers in Adelaide, Australia have spent years researching this question. In a series of studies they have shown that an unhealthy lifestyle has a profound effect on the heart’s atrial chambers. In particular, an excess of fat cells around the heart (pericardial fat) produces changes in the atrial cells, increasing wall stress, inflammation, neural patterns, and increases atrial fibrosis.

All these changes promote atrial fibrillation.

Furthermore, these researchers have now shown in two separate studies that, in patients with atrial fibrillation, an aggressive program promoting lifestyle changes significantly reduces—and may eliminate—this annoying and dangerous arrhythmia.

In the LEGACY trial, the researchers enrolled 335 patients with atrial fibrillation who were overweight (BMI greater than 27) into an intensive lifestyle-moderation program, with a goal of a 10 percent loss in weight.

After one year, those who lost 10 percent of their original weight enjoyed a significant reduction in symptoms of atrial fibrillation and were six times more likely to experience the complete elimination of their arrhythmia, than patients who did not lose weight.

In the ARREST-AF trial, similar lifestyle modifications were applied to patients with atrial fibrillation who were having ablation therapy. This study showed that the results of ablation were significantly better in patients who achieved weight loss. So, lifestyle changes are important even if “traditional” treatments for atrial fibrillation are being employed.

In addition, these studies confirmed that, in patients with atrial fibrillation, weight loss produced favorable changes in the actual structure and function of their atria, explaining why lifestyle measures work.

The Bottom Line

The typical patient with “idiopathic” atrial fibrillation is older, overweight, and sedentary. We now know that the excess weight and lack of exercise is often an important cause of their arrhythmia, and further, that aggressive lifestyle changes can significantly reduce—and even eliminate—their atrial fibrillation.

Because the treatment of atrial fibrillation—whether we’re talking about drugs or ablation—is difficult and only moderately effective, this new knowledge ought to be incorporated into any treatment plan for any patient who has this arrhythmia, and who fits the lifestyle profile.

Unfortunately, aggressive lifestyle management—while safe and effective—is difficult for patients and time consuming for their doctors. And since doctors are paid for doing and not for talking, their incomes would take a hit if they were to rely heavily on lifestyle therapy. So it may be a while before doctors are convinced to adopt this approach and patients are convinced to try it.

Sources:

Abed HS, Samuel CS, Lau DH, et al. Obesity results in progressive atrial structural and electrical remodeling: Implications for atrial fibrillation. Heart Rhythm. 2013; 10:90-100.

Pathak R, et al. Long-term effect of goal directed weight management in an atrial fibrillation cohort: A long-term follow-up study (LEGACY Study). J Am Coll Cardiol. 2015; DOI:101016/jacc.2015.03.002.

Pathak RK, Middeldorp ME, Lau DH, et al. Aggressive risk factor reduction study for atrial fibrillation and implications for the outcome of ablation: The ARREST-AF cohort study. J Am Coll Cardiol. 2014; 64:2222-2231.

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