It Takes a Village to Manage Atrial Fibrillation

Atrial Fibrillation (AFib) is a tough rhythm to manage. To be clear - at this point in time - there is no cure for atrial fibrillation. While this can be a frustrating rhythm to deal with, and more frustrating when recurrences happen, there are options for management. The goal of AFib management is suppression of AFib, which can mean total elimination of AFib or a dramatic reduction of AFib episodes frequency, duration, and intensity.

Management of AFib can include cardioversion (shocking someone to normal rhythm), medical therapy with a variety of options, or invasive procedural approaches with ablation (typically by catheter, though can also be performed with open heart surgery, particularly if done at time of valve or bypass surgery). Success rates of these interventions vary from about 50% to 80%, and very often patients will require more than one intervention to achieve AFib suppression to a level that is acceptable.

But despite the many advancements in treatment of atrial fibrillation over the years with medications and procedures, the management of AFib really does take a village. That is because no matter what interventions are performed, the physician-guided aspect of this management is just a small piece for many patients in the long-term suppression of atrial fibrillation.

What is there beyond medication and ablation? Well, it turns out, there is a lot that can impact the successful suppression of AFib.

1.  Alcohol consumption. While small amounts of alcohol consumption can be beneficial and can boost HDL cholesterol levels, there is also indisputable evidence that alcohol consumption is directly correlated with AFib risk. It is so well known and common that colloquially it is known as "Holiday Heart" when people tend to show up in the ER with AFib around the holidays. While your in-laws may drive you crazy, consider spiking the eggnog with slightly less brandy this year.
2. Caffeine consumption. Like alcohol, some is fine but too much is not a good thing. Just as you may get the jitters from excess caffeine intake, the cardiac tissue becomes more easily excitable (thus making AFib more likely to happen).
3. Smoking. If you are smoking, stop. If you aren't smoking, don't start.
4. Weight control. Obesity is not just tough on your joints, but it is also tough on your heart. Obesity places a lot of strain on your heart and makes AFib more likely to occur. Further, obesity can significantly increase the risk of procedural intervention (or preclude the ability to consider ablation at all). Weight loss is associated with improved AFib suppression, and slow-steady weight loss that is maintained is superior to rapid weight loss that results in yo-yoing.
5. Sleep. Getting enough sleep is important. Everyone's need is different, but if you are suffering from AFib and you think you could benefit from more shut eye, then take the opportunity to accomplish that.
6. Sleep apnea management. If you have sleep apnea, treatment with CPAP (and likely other interventions that are newer to market) is associated with improvement in AFib recurrence rates. If you are not sure if you have sleep apnea but suffer from AFib, difficult hypertension, or other symptoms associated with sleep apnea, consider getting evaluated and treated if diagnosed.
7. Hydrate. Recent studies have shown that the old adage about "8 cups of water a day" is not accurate. We all likely need less than that. However, you should pay attention to your body and drink water when thirsty. And if outside on a hot day, be more aggressive in hydrating. That said, you do not need to drink 80 ounces of water a day, and don't even think about a gallon of water a day!
8. Manage other medical issues. Hypertension, diabetes, heart failure, valve disease, coronary artery disease, smoking, and other lung diseases are just a few of the many medical issues which create strain on the body and make atrial fibrillation more common and harder to manage. Getting these comorbid conditions under better control may also help control your atrial fibrillation long-term.

As you can see, all of those above issues are things that your doctor cannot fix on their own (admittedly they will help manage your comorbid issues), but rather require the buy-in of the patient and the continued effort on their part to address these issues. We cannot make you drink less alcohol or caffeine, quit smoking, lose weight, sleep more or wear your CPAP at night, among other things. But, without efforts by the patient to improve their health, efforts of the physician to suppress atrial fibrillation are likely to be less successful. Successful management of AFib requires buy-in from both physician AND patient.