Heart Health Heart Disease Atrial Fibrillation Atrial Fibrillation Guide Atrial Fibrillation Guide Symptoms Causes Diagnosis Treatment Coping Causes and Risk Factors of Atrial Fibrillation By Richard N. Fogoros, MD facebook linkedin Richard N. Fogoros, MD, is a retired professor of medicine and board-certified in internal medicine, clinical cardiology, and clinical electrophysiology. Learn about our editorial process Richard N. Fogoros, MD Medically reviewed by Medically reviewed by Jeffrey S. Lander, MD on July 22, 2020 twitter linkedin Jeffrey S. Lander, MD, is a board-certified cardiologist and the incoming President and Governor of the American College of Cardiology, New Jersey chapter. Learn about our Medical Review Board Jeffrey S. Lander, MD on July 22, 2020 Print Atrial fibrillation, sometimes abbreviated as Afib, is a fast and very irregular heart rhythm caused by extremely rapid and chaotic electrical impulses originating in the heart's atria (the two upper cardiac chambers). It can develop due to abnormalities of the heart structure that you are born with, or after damage to the heart, such as occurs with high blood pressure, coronary artery disease, or a heart attack. In some people, atrial fibrillation occurs without any heart defects or damage, and it is often seen in people who are older, overweight, and sedentary. Worldwide, atrial fibrillation is one of the most common arrhythmias that doctors see in their practices. sudok1 / Getty Images Common Causes Atrial fibrillation appears to be related to changes that can occur within the atrial muscle, chiefly inflammation, fibrosis, and increased pressure in the atrial chambers. These changes can disrupt the way atrial tissue handles the electrical impulses of the heart, resulting in atrial fibrillation. One condition that produces these disruptive changes in atrial tissue is atrial fibrillation itself. Once atrial fibrillation occurs, it is more likely to come back again—and to get worse as time goes by. Some experts say, “atrial fibrillation begets atrial fibrillation.” This is one reason atrial fibrillation is thought to be a progressive problem, with episodes gradually becoming more frequent and lasting longer as time passes. Heart Conditions Almost any cardiac disease can increase the stress on atrial tissue, producing the kinds of inflammation and fibrosis associated with atrial fibrillation. These can be conditions that develop over time or ones you are born with (such as malformed heart valves). Damage to your heart due to a heart attack, inflammation of the heart muscle or heart lining, and heart surgery are risk factors for atrial fibrillation. Chronic conditions that damage the heart, especially uncontrolled high blood pressure, raise your risk as well. The heart problems most likely to be accompanied by atrial fibrillation are: Valvular heart disease, especially rheumatic heart disease Coronary artery diseaseHeart failureHypertrophic cardiomyopathyCongenital heart diseaseSinus node disease (sick sinus syndrome)Other cardiac arrhythmias, especially supraventricular tachycardiaChronic hypertensionCardiac surgery Non-Cardiac Conditions Several non-cardiac conditions also greatly increase the risk of developing atrial fibrillation. These include: Pulmonary embolusPneumoniaDiabetesSleep apneaChronic kidney diseaseHyperthyroidismDysautonomiaHigh birth weight The prevalence of atrial fibrillation is strongly associated with age. While less than 1% of adults under 50 have atrial fibrillation, 9% of people 80 or older have it. Genetics While the propensity for atrial fibrillation seems to be higher in some families, the genetic contribution to this arrhythmia is very complex. Still, a history of atrial fibrillation in a close relative significantly increases your risk of developing this arrhythmia. Familial atrial fibrillation may be a factor in up to 30% of cases of idiopathic atrial fibrillation. It may be caused by a single gene mutation or a mix of genes, along with environmental or lifestyle risk factors. KCNQ1 is one gene that has been identified. It is inherited in the autosomal dominant pattern, which means that it affects both men and women equally and that you are likely to display symptoms if you have the gene. Either parent would have atrial fibrillation, and any children inheriting the gene are likely to experience atrial fibrillation. This gene directly affects the ability of the heart muscle cells to bring potassium ions into and out of the cell, as is needed for producing the heart rhythm. Other genes have been found that affect ion channels and can cause atrial fibrillation. Mutations in genes that affect the development of the heart as well as muscle cells in the heart before birth are also a genetic cause of atrial fibrillation. These can affect the structure and the function of the heart. Some inherited gene mutations work in combination with other factors to raise the risk of developing atrial fibrillation. When combined with other conditions, such as high blood pressure, diabetes, or atherosclerosis, you are at increased risk. Lifestyle Risk Factors Doctors are just now becoming aware of the extent to which atrial fibrillation is a lifestyle disease. The typical patient a doctor sees with atrial fibrillation likely has no identifiable underlying cause (that is, no structural heart disease, diabetes, sleep apnea, or any of the other conditions listed above). But they are often older, overweight, and sedentary. It is becoming more and more evident that being overweight and not getting much exercise are strongly associated with atrial fibrillation. Lifestyle factors that affect your risk of atrial fibrillation are, to a large extent, within your control, such as the following. Obesity People whose body mass index (BMI) is greater than 30 kg/m2—that is, those who are classified as being medically obese—have a significantly higher risk of atrial fibrillation than those whose BMI is below 25. Obesity is associated with elevated left atrial pressures, and also with increased pericardial fat (fatty deposits on the pericardium, which is the outside layer of the heart). Both of these factors are thought to contribute to obesity-associated atrial fibrillation. Sedentary Lifestyle Several studies have now demonstrated that a very sedentary lifestyle can significantly predispose people to atrial fibrillation. Indeed, at least two studies have shown that, in obese, sedentary people with atrial fibrillation, a strict lifestyle modification program that achieved weight loss and physical conditioning significantly reduced, and sometimes eliminated, the risk of subsequent atrial fibrillation. These lifestyle-induced improvements in atrial fibrillation are accompanied by measurable improvements in the heart itself—reductions in pericardial fat deposits, and in atrial fibrosis and inflammation. Alcohol Use Binge drinking commonly triggers atrial fibrillation. Most of the time, atrial fibrillation in drinkers follows a night or weekend of heavy drinking, a condition dubbed “holiday heart.” In addition, newer studies also suggest that even moderate alcohol intake increases the risk of atrial fibrillation. Air Pollution In at least one prospective study, the concentration of particulate air pollution was associated with a higher risk of atrial fibrillation. What About Caffeine? Despite the fact that doctors often tell patients with atrial fibrillation (and other arrhythmias) to avoid caffeine, studies have failed to demonstrate that caffeine, in quantities typically consumed, has any effect whatsoever on any cardiac arrhythmias. Preventing Atrial Fibrillation To reduce your risk of cardiovascular disease and, as a result, atrial fibrillation: Don’t smoke. Smoking tobacco is probably the most powerful and reliable way to increase your risk of heart disease.Keep your weight down.Eat a heart-healthy diet. While the “best” diet to prevent heart disease is a point of continuing controversy, most experts now agree that a Mediterranean-style diet is good for the cardiovascular system. Foods high in omega-3 fatty acids, such as fish, are excellent choices.Get plenty of exercise. A sedentary lifestyle is bad for your health in so many ways. We can now add atrial fibrillation to the list.Check your blood pressure regularly. If you develop hypertension, make sure it is adequately treated.Make sure your doctor is checking your cholesterol levels and thinking about whether you need to take action to improve them.If you drink alcohol, do so only in moderation. A Word From Verywell While many doctors regard atrial fibrillation as “just one of those things” that happens to certain people, there are clearly steps you can take to alter that fate. Most of these risk-reduction strategies are the very same things that can reduce your risk of cardiovascular health issues in general. By preventing coronary artery disease, heart failure, and hypertensive heart disease, you will also be lowering your risk for diabetes, sleep apnea, obesity, pulmonary embolus, and cardiac surgery. Avoiding all these conditions will eliminate some of the most powerful risk factors for atrial fibrillation. How Atrial Fibrillation Is Diagnosed Was this page helpful? Thanks for your feedback! Did you know the most common forms of heart disease are largely preventable? Our guide will show you what puts you at risk, and how to take control of your heart health. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Brandes A, Smit MD, Nguyen BO, Rienstra M, Van gelder IC. Risk Factor Management in Atrial Fibrillation. Arrhythm Electrophysiol Rev. 2018;7(2):118-127. doi:10.15420/aer.2018.18.2 Gutierrez C, Blanchard DG. Diagnosis and Treatment of Atrial Fibrillation. Am Fam Physician. 2016;94(6):442-52. Familial Atrial Fibrillation. Genetics Home Reference. National Institutes of Health. Staerk L, Sherer JA, Ko D, Benjamin EJ, Helm RH. Atrial Fibrillation: Epidemiology, Pathophysiology, and Clinical Outcomes. Circ Res. 2017;120(9):1501-1517. doi:10.1161/CIRCRESAHA.117.309732 Abed HS, Wittert GA, Leong DP, et al. Effect of weight reduction and cardiometabolic risk factor management on symptom burden and severity in patients with atrial fibrillation: A randomized clinical trial. JAMA. 2013;310(19):2050-2060. doi:10.1001/jama.2013.280521 Monrad M, Sajadieh A, Christensen JS, et al. Long-Term Exposure to Traffic-Related Air Pollution and Risk of Incident Atrial Fibrillation: A Cohort Study. Environ Health Perspect. 2017;125(3):422-427. doi:10.1289/EHP392 Caldeira D, Martins C, Alves LB, et al. Caffeine does not increase the risk of atrial fibrillation: A systematic review and meta-analysis of observational studies. Heart. 2013;99:1383-1389. Elliott AD, Maatman B, Emery MS, Sanders P. The role of exercise in atrial fibrillation prevention and promotion: Finding optimal ranges for health. Heart Rhythm. 2017;14(11):1713-1720. doi:+10.1016/j.hrthm.2017.07.001 Additional Reading Familial Atrial Fibrillation. Genetics Home Reference. National Institutes of Health. Abed HS, Wittert GA, Leong DP, et al. Effect of weight reduction and cardiometabolic risk factor management on symptom burden and severity in patients with atrial fibrillation: a randomized clinical trial. JAMA. 2013;310(19):2050-60. doi:0.1001/jama.2013.280521 Abed HS, Wittert GA, Leong DP, et al. Effect of Weight Reduction and Cardiometabolic Risk Factor Management on Symptom Burden and Severity in Patients With Atrial FibrillationA Randomized Clinical Trial. JAMA 2013; 310:2050. doi:10.1001/jama.2013.280521 Caldeira D, Martins C, Alves LB, Pereira H, Ferreira JJ, Costa J. Caffeine does not increase the risk of atrial fibrillation: a systematic review and meta-analysis of observational studies. Heart. 2013;99(19):1383-9. doi:10.1136/heartjnl-2013-303950 January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society. Circulation 2014; 130:e199. doi:10.1161/CIR.0000000000000041 Monrad M, Sajadieh A, Christensen JS, et al. Long-Term Exposure to Traffic-Related Air Pollution and Risk of Incident Atrial Fibrillation: A Cohort Study. Environ Health Perspect. 2017;125(3):422–427. doi:10.1289/EHP392 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. doi:10.1016/j.jacc.2014.09.028 Staerk L, Sherer JA, Ko D, Benjamin EJ, Helm RH. Atrial Fibrillation: Epidemiology, Pathophysiology, and Clinical Outcomes. Circ Res. 2017;120(9):1501–1517. doi:10.1161/CIRCRESAHA.117.309732