Simple lifestyle changes can help to both prevent and treat this common heart condition.
The most common cardiac arrhythmia, atrial fibrillation (AF), affects up to 500,000 Canadians and contributes to approximately one quarter of strokes among people over 40 years of age. Vancouver Coastal Health Research Institute scientist Dr. Jason Andrade — who was named a ‘World Expert on Atrial Fibrillation’ by Expertscape — shares his insights into the latest approaches to prevent and treat AF.
Q: What is AF and what typically causes it?
A: At its core, AF is caused by electrical signal irregularities in the top chambers of the heart that result in a chaotic and unusually rapid heartbeat. The likelihood of developing the condition increases with age, as well as with the severity and number of risk factors someone has, such as hypertension, diabetes, sleep apnea and obesity.
While rarely life-threatening, AF can significantly impair the activity levels and quality of life of people affected by it. It substantially increases the risk of thromboembolic events, such as stroke, and puts patients at risk of developing ventricular dysfunction, such as heart failure, both of which contribute to an increased risk of morbidity and mortality.
Q: Is it related to high blood pressure or high cholesterol?
A: While there is no relationship between AF and high cholesterol, high blood pressure—also known as hypertension—is the most significant modifiable risk factor for AF. In many cases, even people who fall within the higher end of the ‘normal’ range of blood pressure may still be at risk. For example, a systolic blood pressure in the pre-hypertensive range of 130-139 mmHg has been associated with a 28 per cent higher risk of developing AF compared to a range below 120 mmHg.
Q: Could I have inherited it from my parents?
A: There is a genetic susceptibility that exists for all heart rhythm disorders. However, genetic susceptibility does not mean that someone will definitely develop AF. Additionally, there are many underlying health conditions that can be effectively treated to help stymie the development of an arrhythmia.
Q: Are there natural remedies or lifestyle changes that can help manage it?
A: Research has shown that lifestyle modifications significantly decrease the incidence of AF and improve quality of life for those affected. In fact, research has shown that patients who chose to undergo aggressive risk factor modification had better symptom control, a significant reduction in AF burden and greater freedom from recurrent AF compared to those who did not.
The 2020 Canadian Cardiovascular Society AF guidelines recommend that patients with AF undertake a tailored and individualized exercise prescription of at least 30 minutes of moderate intensity aerobic and resistance exercise at least three to five days per week (targeting 200 minutes a week).
Additional modifications that older adults can make to manage AF include aiming to lose at least 10 per cent of their body weight to a target BMI of less than 27 kg/m2, maintaining their blood pressure to a target of less than 130/80 mmHg and limiting alcohol consumption to less than or equal to one standard drink per day.
Q: What are the most recent and best medical practices to treat AF?
A: The contemporary management of AF is centered on symptom improvement, and reducing morbidity, mortality and AF-related emergency room visits or hospitalizations. Given this, treatment plans typically focus on using a combination of medications and procedures in order to control the heart rate or heart rhythm, as well as medications to reduce the risk of stroke.
My recent research studied the question of which treatment is the most effective for the management of patients with highly symptomatic AF. Our findings showed that a catheter ablation procedure—a minimally invasive day surgery—is more effective at controlling an arrhythmia. It also showed greater improvements in quality of life, and reduced patients’ need to access health care resources.