Is Atrial Fibrillation a Lifestyle Disease?

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.

Healthcare providers 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—lifestyle choices, specifically being overweight and sedentary.

Woman sitting on the couch
Cornelia Schauermann / Getty Images

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 atrial fibrosis. All these changes promote atrial fibrillation.

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

In the LEGACY trial, 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 made by 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. Therefore, 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.

Bottom Line

The typical patient with “idiopathic” atrial fibrillation is older, overweight, and sedentary. We now know that 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—can be difficult for patients. But even small changes in physical activity levels can make a big difference in overall health. If you've been diagnosed with atrial fibrillation or want to prevent it, talk with your healthcare provider about starting a safe exercise program tailored to your interests and goals.

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By Richard N. Fogoros, MD
Richard N. Fogoros, MD, is a retired professor of medicine and board-certified in internal medicine, clinical cardiology, and clinical electrophysiology.