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Lifestyle for Managing Atrial Fibrillation

Research shows that managing lifestyle risk factors may have a powerful effect on afib. Some risk factors, such as age, cannot be controlled. However, others can, including obesity, high blood pressure, sleep apnea, and diabetes. Some might even be reversible. For example, weight loss and exercise have significantly decreased afib burden (the amount of afib you have) for many people.

Therefore, “lifestyle and risk factor management” has been declared the fourth pillar in managing afib, alongside rate control and rhythm control of the heart and stroke prevention.

Lifestyle risk factors for afib are frequently shared with other cardiovascular conditions, such as heart disease and stroke. The following sections include some of the things we know from lifestyle research.¹

Obesity and Higher BMI

•  Obesity is a strong risk factor for afib, with the Framingham Heart Study showing that afib risk increases 1.5-fold from obesity.
• Obesity and high body mass index (BMI) increase afib burden and progression from paroxysmal to persistent afib.
• Obesity increases the risk of postoperative afib (POAF) and afib after ablation.
• According to the REVERSE-AF trial (a subanalysis of the LEGACY study), a 10% reduction in weight has been shown to decrease afib burden, symptoms, and progression to persistent afib.
• Bariatric surgery in those with high BMI is associated with reduced risk for afib and reduced recurrence after ablation.

Exercise and Physical Activity

• Current exercise recommendations are for getting moderate-intensity exercise of 150 min/wk or vigorous aerobic exercise of 75 min/wk.
• Physical activity may help to offset the afib risk from obesity.
• Extreme endurance exercise appears to increase the risk of developing afib by 5-fold.

 Sleep Apnea and Sleep-Disordered Breathing

•  Studies show that sleep apnea in those with afib ranges from 21% to 87%.
• People with sleep-disordered breathing have a 2-fold increased afib risk.
• Sleep-disordered breathing is a risk factor for cardiovascular disease. The association with afib is thought to relate to shared risk factors such as increasing age, being male, obesity, and high blood pressure.
• Though research findings vary, sleep apnea treatment may decrease afib burden and lead to better afib outcomes.
• Those with severe sleep-disordered breathing appear less likely to respond to antiarrhythmic medications.
• Those undergoing cardioversion have a lower recurrence of afib when treated with continuous positive airway pressure (CPAP) machines.
• In the ORBIT-AF study, those using CPAP were less likely to progress to a more permanent type of afib.
• After ablation, those treated with CPAP have fewer afib recurrences. In fact, research shows that those using a CPAP have similar results following ablation as those without sleep-disordered breathing at all.

Diabetes

• Structural, electrical, and autonomic changes in the heart may occur due to diabetes.
• Those with diabetes have nearly a 40% increased risk of developing afib.
• Appropriate blood sugar (glycemic) control is associated with a reduced risk of afib.

High Blood Pressure

• High blood pressure is the risk factor found most often in those with afib.
• High blood pressure appears to be associated with the risk of afib because they share common risk factors.

Other Lifestyle Risk Factors

• Heart failure and afib often exist together. Therefore, it is essential to treat heart failure and related risk factors and consider catheter ablation or surgery to stop the afib and heart failure.
• While high cholesterol is a cardiovascular risk factor, there is little data on whether or how it might affect afib and what impact cholesterol-lowering medications might have. Cholesterol-lowering medications lower inflammation, and inflammation appears to be associated with afib. Therefore, there is a possibility that these medications might help with afib, but much more research is needed.
• Stopping smoking is vital in managing afib.
• While we’re often told to limit caffeine, lowering or limiting caffeine shows little influence on afib.
• Studies show that reducing alcohol intake is vital in managing afib. Nevertheless, some people in the afib community have found that stopping alcohol intake did not stop their afib.

Controlling risk factors has been shown to help maintain sinus rhythm without rhythm control medications in up to 40% of patients (LEGACY). Further, research shows that managing risk factors can reduce afib burden as much or more than catheter ablation or surgery. Managing risk factors improves the results of catheter ablation or surgery, too.

To learn about other treatment options for afib, see Medications for Afib, Procedures for Afib, or Create an Effective Healthcare Team.

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