It seems as though the COVID-19 pandemic has taken up all my time and attention over the past few weeks. However, there are still other topics of interest to share.

Atrial fibrillation (AF) is a common cause of irregular health rhythm when the top part of the heart (the atria) just quivers and the bottom part of the heart (the ventricles) contracts without its usual regularity.

The portion of the population with AF increases with age to the point that about one third of people over 80 years old will have AF.

Often AF occurs in intermittent episodes. But if it persists, it is treated with medications to keep the heart rate from going too fast and with blood thinners to keep blood clots from forming and being pumped out of the heart causing strokes or other damage to the body. In some patients, AF is treated with ablation, which scars small areas of the heart to control the rhythm.

Although we cannot avoid aging, there are other lifestyle factors that can affect the incidence of atrial fibrillation according to a recent scientific statement from the American Heart Association.

These lifestyle risk factors for AF include obesity, physical inactivity, sleep apnea, diabetes mellitus, hypertension, cigarette smoking and excessive alcohol intake.

The AHA document was issued because recent studies have demonstrated the benefits of lifestyle changes in keeping AF from happening initially or recurring in those people with previous episodes of AF that reverted to a regular heart rhythm.

Experts suggest that lifestyle changes are the fourth pillar of AF care, in addition to anticoagulation (blood thinners) and rate and rhythm control.

We have known for a while that AF is associated with several lifestyle stressors, such as obesity and lack of physical activity. But studies from Australia have shown that if overweight people can reduce their weight by 10% and people can increase their physical activity by 2 METS (using twice the energy used by the body at rest), AF incidence will be decreased.

Bariatric surgery for obese patients has also been associated with reduced risk for new AF and reduced recurrence after AF treatment with ablation. It would be best to achieve a body mass index (BMI) of 25 or less.

Regular aerobic exercise is also effective in reducing AF and improving AF-related symptoms and quality of life. Moderate exercise does not increase the risk for AF and appears to be beneficial. But it is possible to get too much of a good thing since extreme levels of exercise may be associated with a higher risk for AF.

People should aim for at least the AHA physical activity guidelines for the general population. The advice for the general population is 150 minutes each week of moderate-intensity exercise.

The prevalence of sleep-disordered breathing is high among patients with AF. Patients with sleep apnea who receive therapy with continuous positive airway pressure (CPAP) appear to have a lower risk for AF recurrence after AF ablation. Thus, screening for and treatment of sleep-disordered breathing are important components of lifestyle modification for patients with AF.

Diabetes mellitus is associated with a higher risk for AF. Good blood sugar control has been associated with reduced risk for AF and may be important for reducing recurrent AF.

High blood pressure (hypertension) is also associated with risk of developing AF. Blood pressure management should include management of the same lifestyle factors already mentioned (obesity, physical inactivity and diet), along with medication.

Other lifestyle interventions that could help reduce AF burden include smoking cessation, reduction of alcohol intake and optimization of treatments for heart failure and hyperlipidemia.

Many of us have difficulty achieving lifestyle modifications on our own. So, talk to your friends and family as well as your health care provider for support and instruction. Consider visiting a wellness center and/or enlisting the help of a coach to help you stay on course for better health.

Dr. Terry Gaff is a physician in northeast Indiana. Contact him at or on Facebook. To read past columns and to post comments go to

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