Afib is a type of heart rhythm disorder that starts in the upper chambers of your heart, known as the atria. “With afib, the top of the heart quivers instead of contracting. As a result, blood clots can collect, which puts people at increased risk for stroke,” says Corrine Jurgens, PhD, associate professor at the Connell School of Nursing at Boston College and spokesperson for the American Heart Association. The good news is that there are ways to prevent it. “Many patients with atrial fib don’t have symptoms,” Dr. Jurgens says. Just as you can have atrial fibrillation without visible symptoms, you can experience an attack of atrial fibrillation without a trigger. But most people are able to identify at least some of their afib triggers, and this knowledge can help decrease the frequency of attacks and lower your risk for stroke. Which afib triggers should be on your radar? Here are five of the lesser-known triggers that can be harmful to your heart.
1. Drinking Any Amount of Alcohol
Old rule: If you have afib, it’s okay to drink, as long as it’s in moderation. New rule: Any amount of alcohol can increase the risk of an afib episode. A study published in Novembe 2021 in the Annals of Internal Medicine found that the risk of an afib episode was 2 times higher after one alcoholic drink and greater than 3 times higher after at least two drinks four hours after consuming an alcoholic beverage. “If you want to minimize afib recurrences, zero alcohol is probably best,” says Jim Cheung, MD, chair of the American College of Cardiology Electrophysiology Council and professor of medicine at Weill Cornell Medicine in New York City. “But, as in all things in life, you have to balance things with whatever pleasure you derive from having the occasional drink or two.”
2. Stressing Out
“It’s difficult to prove an association between afib triggers and stress, but there have been a number of studies linking practicing yoga with reducing afib occurrences,” Dr. Cheung says. These studies suggest that reducing stress (with yoga) may help improve afib symptoms. A review published in February 2021 in the International Journal of Yoga, for example, in which study authors reviewed six studies involving 231 participants, found that yoga was effective in reducing the number of afib episodes as recorded by patients themselves and on heart monitors before practicing yoga and afterward. Two of the six studies reported less depression and anxiety after the yoga phase, compared with the groups who didn’t practice yoga. In the review, participants practiced yoga 45 to 60 minutes for one to six days per week, for two to three months. Pranayama, a deep breathing technique, was the most common form of yoga practiced in all the studies. A study published in August 2022 in JACC: Clinical Electrophysiology suggested that afib may cause stress and, likewise, stress can cause afib. The study authors recommend that doctors focus on the impact a heart-rhythm disorder may have on person’s mental health, rather than just the physical symptoms alone. When counseling people with afib, study authors recommend mentioning treatments to reduce stress, such as antidepressant therapy, mindfulness-based stress reduction, and yoga.
3. Smoking Marijuana
While marijuana or cannabis is widely used around the world, there is limited knowledge about its safety in people with afib. But studies are starting to reveal compelling evidence. In a study published in September 2021 in Pacing and Clinical Electrophysiology, researchers tracked hospital admissions for people with afib and cannabis use disorder (CUD), in which someone has constant cravings for cannabis and can’t stop using it to the point that it interferes with daily life. They found that from 2008 to 2018, people hospitalized for afib who also had CUD more than doubled — from 0.3 percent to 1.3 percent. On average, the hospitalized patients were 52 years old. “Cannabis can trigger symptoms in people with preexisting heart disease like afib,” says Jurgens.
4. Cutting Down on Healthy Carbs
Can a diet low in carbs like grains, fruits, and veggies trigger afib episodes? A study published in April 2019 in the Journal of the American Heart Association provides food for thought. The research, which tracked the diets of nearly 14,000 people for roughly 22 years, found that low-carb diets were linked to an increased risk of afib incidents. The relationship between a low-carb diet and heart disease risk is controversial, but researchers speculate that skimping on healthy carbs, such as fruits, vegetables, and grains, and eating refined carbs such as certain breads and crackers may increase inflammation and oxidative stress (when oxygen-containing molecules outnumber the antioxidants in the body). Both cellular processes may pave the way for afib. As far as beverages go, on the other hand, if you enjoy a cup of java, you’re in luck. Historically, people with afib have been warned about the potential harm of drinking caffeine. But a study published in August 2019 in the Journal of the American Heart Association found that participants who drank one to three cups of coffee per day had a lower risk of afib. “Caffeine has been found to be protective against afib, which is a good thing because I love my two cups of coffee in the morning,” Jurgens says.
5. Not Getting Enough Sleep
“Sleep apnea has clearly been linked to afib,” says Cheung. The sleep disorder can cause changes in heart function and structure, including enlarging the atria, one of the heart’s chambers, which may make you more susceptible to afib. “If we put patients with afib and sleep apnea on a CPAP machine, it can reduce the diameter of their atria and things can improve,” Jurgens says. CPAP (continuous positive airway pressure) is a machine that uses mild air pressure to keep airways open while you’re sleeping. But even if you’re routinely having trouble sleeping well, it can up your afib risk. A study published in September 2021 in the Journal of the American College of Cardiology involving over 400,000 participants in the UK Biobank, a large-scale database of health and genetic information, found that roughy 86,000 people who had a sleep score of 5 (a healthy sleep pattern) had a lower risk of developing afib, compared with people who had frequent bouts of insomnia, snoring, and daytime sleepiness. Study participants were asked to rate their sleep patterns on a scale from 1 to 4 or greater, with 4 or greater indicating the healthiest sleep pattern, meaning generally free of snoring, insomnia, and daytime sleepiness, and who slept seven to eight hours each night. “In medicine, a lot of our work is focused on medications and surgical procedures, but it’s important to focus on lifestyle factors for atrial fibrillation,” Cheung says. “You want to make sure you get adequate sleep, exercise regularly, and lose weight if you need to.” According to the American Heart Association, those lifestyle strategies, as well as not smoking, eating a heart-healthy diet, managing blood pressure, and controlling cholesterol have been shown to prevent afib and its complications.
Detecting Afib With the Apple Watch
Could you have afib and not know it? It’s possible. “A significant proportion of people with afib don’t have symptoms. But with the advent of smartphones and wearable devices, we are finding increasing rates of afib being detected,” Cheung notes. Devices using the latest Apple WatchOS 9, which has an FDA-approved afib History feature, can estimate how frequently a person shows signs of an irregular and rapid heartbeat. But it’s important to note that some changes in heart rhythm are normal. “The latest version of the Apple Watch features a rhythm strip you can bring to your doctor, which can take some of the guesswork out of whether you actually have afib,” Jurgens says. Additional reporting by Sandra Gordon.
