Beforehand, the Skeptical Cardiologist answered the concern “Why did I go into atrial fibrillation (AF)?“
An similarly critical problem is “How can I minimize the prospects that I have extra spells of atrial fibrillation?”
I commit a good quantity of time speaking about with my AF sufferers what life style adjustments they can make in this regard. I have identified, even so, that lots of AF individuals I am looking at for a second viewpoint look unaware of the improvements they can make to lower AF recurrence.
Herein, I give you the 8 most critical alterations you can make to lessen both of those the onset and the recurrence of AF.
- Remove or significantly lessen liquor ingestion.
- Get rid of excess weight if you are overweight.
- Quit cigarette smoking. Stopping is related with a 36% decreased danger of AF.
- Get your blood stress underneath very good command.
- Get standard cardio workout. At minimum 150 minutes of reasonable cardio exercising weekly.
- Try to eat a healthful diet plan. Don’t take in crap, as “Younger Upcoming Calendar year” claims. In standard, what ever food plan approach has you at a BMI <28 is fine. Healthy diets controlling weight avoid ultra-processed foods, sugar-sweetened beverages, and minimize white rice, pasta, pastries, and potatoes. These diets include lots of fresh vegetables, nuts, olive oil, and fish. Full-fat yogurt and cheese are fine in moderation. Eat real food, mostly plants, not too much, as Michael Pollan has famously said.
- Get high-quality sleep. This means treating any sleep apnea properly, in addition to standard advice for getting a good night’s sleep. The risk of AF is four times higher with obstructive sleep apnea (OSA) independent of other confounding variables.
- Reduce stress. Easier said than done, I know. Everything from meditation to yoga to retiring or cutting back at work to psychotherapy can be tried in this category. Go with whatever works for you. Knowing when you are in or out of AF by utilizing personal ECG monitoring devices may help reduce stress, especially if used under physician supervision.
Let’s dig a little deeper into some specific recent evidence on three aspects that have a huge impact: alcohol, exercise, and obesity.
Alcohol and AF
In March, I wrote about the Alcohol-AF trial recently published in the New England Journal of Medicine:
Binge alcohol consumption (holiday heart) can trigger atrial fibrillation (AF) and observational studies show a higher incidence of AF with higher amounts of alcohol consumption.
This trial was the first-ever randomized controlled trial of alcohol abstinence in moderate drinkers with paroxysmal AF (minimum 2 episodes in the last 6 months) or persistent AF requiring cardioversion.
Participants consumed ≥10 standard drinks per week and were randomized to abstinence or usual consumption. Participants underwent comprehensive rhythm monitoring with implantable loop recorders or existing pacemakers and twice-daily AliveCor monitoring for 6 months.
Abstinence prolonged AF-free survival by 37% (118 vs 86 days) and lowered the AF burden from 8.2% to 5.6%. AF related hospitalizations occurred in 9% of abstinence patients versus 20% of controls. Participants in the abstinence arm also experienced improved symptom severity, weight loss and BP control.
This trial gives me precise numbers to present to my AF patients to show them how important eliminating alcohol consumption is if they want to have fewer AF episodes. The study further emphasizes lifestyle changes (including weight loss, exercise, and stress reduction) can dramatically reduce the incidence of AF.
Obesity and AF
We have known for some time of a strong association between obesity and atrial fibrillation. We also know we can make sheep go into atrial fibrillation by making them obese and creating a diseased, fat-infiltrated left atrium.
More recently, we have solid evidence that sustained weight reduction can significantly reduce the recurrence of AF.
The Australian LEGACY study took 355 AF patients with BMI>27 and supplied them a pounds management software with annually body weight stick to-up. Endpoints incorporated effect on the AF severity scale and 7-working day ambulatory checking.
Excess weight reduction ≥10% resulted in a six-fold bigger chance of no AF recurrences compared with lesser degrees of weight reduction. Massive excess weight fluctuations doubled the threat of AF recurrence.
Of system, all these things are interrelated. Training, diet plan, pressure, liquor usage, and snooze quality all impact body weight management and obesity. People with AF should be performing on all eight levers for optimum gain.
Presented the LEGACY analyze results, men and women who have AF and are obese need to be making use of all life style things at their disposal to get entire body pounds down 10% in a slow and continuous fashion with life-style changes that are sustainable for the relaxation of their lifestyle. They will need to lose that excess weight and continue to keep it off.
Exercise and AF
The most persuasive proof for the independent function of exercise in decreasing AF will come from a Norwegian examine of 51 people with AF who ended up randomized possibly to cardio interval coaching (AIT) or to their common workout routines. The individuals randomized to AIT engaged in 4 4-minute bouts of high-intensity (85% to 95% peak heart price) cardio work out interspersed with 3 minutes of recovery.
There was a major reduction in AF burden (measured by implanted loop recorders) in the physical exercise team, with the suggest time in AF dropping from 8.1% to 4.8%, with no substantial change in the manage team. Sufferers in the exercising team expert much less and significantly less severe indications whereas the non-working out handle group experienced no adjust. In comparison with controls, patients randomly assigned to work out also greater their peak oxygen consumption (VO2peak), cardiac function, and high-quality of life, although strengthening human body mass index and blood lipids.

Signify adjustments from baseline to abide by-up have been −6.2 percentage details (pp), P=.02 for exercising 4.8 pp, P=.09 for command and 11. pp, P=.007 in between groups.
An accompanying editorial supplies this graphic on the advantages of exercise instruction in AF:

Persons with out AF can lower hazard of AF by next these way of life tips, far too. A PDF summary of the 8 variables is available listed here.
For those people wishing to mimic the Norwegian AIT protocol, below is the total description:
Stamina coaching was done as strolling or functioning on a treadmill 3 situations a week for 12 months. Each session commenced with a 10-moment warmup at 60% to 70% of maximal coronary heart charge obtained at exercise screening (HRpeak), adopted by 4 4-minute intervals at 85% to 95% of HRpeak with 3 minutes of active recovery at 60% to 70% of HRpeak amongst intervals, ending with a 5-minute cooldown period of time. During AF, clients exercised at the exact same treadmill pace and inclination as in the previous periods in sinus rhythm, with the Borg scale of 6 to 20 as an help to management depth. When acquainted with the teaching routine, clients have been allowed to carry out 1 physical exercise for each 7 days at house, exactly where physical exercise intensity was documented with a coronary heart charge watch (RS300X, Polar Electro, Kempele, Finland).
Anthony Pearson, MD, is a personal exercise noninvasive cardiologist and health care director of echocardiography at St. Luke’s Medical center in St. Louis. He weblogs on nourishment, cardiac tests, quackery, and other factors worthy of skepticism at The Skeptical Cardiologist, the place a variation of this publish to start with appeared.