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Atrial fibrillation is the most common heart rhythm disorder in adults and can cause symptoms such as palpitations, irregular heartbeat, fatigue and shortness of breath – but sometimes it is not noticeable at all. The risk increases with age, heredity and cardiovascular disease, but many important risk factors can be influenced. High blood pressure, obesity, alcohol, smoking, sleep apnea and certain diseases such as diabetes and overactive thyroid can contribute to the development of atrial fibrillation. Early detection and treatment of these factors is important because atrial fibrillation increases the risk of stroke and heart failure. Through healthy lifestyle habits, regular check-ups and treatment of underlying diseases, the risk can be reduced and heart health can be improved.
People affected by atrial fibrillation describe it as having a diffuse onset: the heart races, beats unevenly or feels "fluttering", sometimes accompanied by fatigue, shortness of breath or reduced energy. At the same time, there are other people who do not notice anything at all until an ECG, a health check or an investigation of high blood pressure shows that the rhythm is not normal. It is precisely for this reason that knowledge about the risk factors and causes of atrial fibrillation is important to have. Some we cannot influence, such as age and heredity. But many of the other risk factors can actually be changed - for example, blood pressure, weight, drinking habits, sleep and other underlying diseases. Current guidelines clearly emphasize that the treatment of atrial fibrillation is not only about drugs and procedures, but also about finding and influencing the risk factors that lie behind and cause the condition.
Risk factors and causes you can – and cannot – influence
In atrial fibrillation, electrical signals occur in the atria of the heart that occur irregularly, causing the heart to beat rapidly and irregularly. It can cause symptoms, but it can also be silent. The important thing is that the condition not only affects quality of life, it also increases the risk of blood clot, stroke and heart failure if it is not detected and treated.
Are there causes of atrial fibrillation that cannot be influenced?
Yes, there are several causes of atrial fibrillation that you unfortunately cannot fully control. These include, in particular:
Older age – the risk increases clearly with age.
Heredity – atrial fibrillation can occur more often in some families.
Congenital or structural heart defects – for example, valvular disease or previous heart surgery.
Previous cardiovascular disease – such as heart attack, heart failure or coronary artery disease.
However, this does not mean that the development of atrial fibrillation is “predestined” – on the contrary, modern healthcare shows that people with congenital vulnerability are often greatly influenced by factors that can be prevented and influenced, such as high blood pressure, obesity, alcohol or sleep apnea.
It is therefore possible to have a background risk – but still reduce the total load on the heart.
What causes can be affect?
There are many conscious choices you can make in your everyday life to reduce your risk of atrial fibrillation, here are 4 risk factors you can actually prevent:
High blood pressure – this is one of the most important risk factors for atrial fibrillation. The heart is put under more strain when blood pressure is too high for a long time. The heart muscle and atria can change structurally, which makes the electrical signals more easily disrupted. Therefore, controlling blood pressure is a key factor, both in preventing atrial fibrillation and in reducing sequelae such as stroke and heart failure.
Overweight and obesity – these are also factors that increase the risk. Fat tissue is not only a “storehouse” of energy, but also affects the body biologically through inflammation, hormonal signals and increased strain on the heart and blood vessels. Obesity is also often associated with high blood pressure, insulin resistance, sleep apnea and poor fitness – all of which are factors that together drive the risk of atrial fibrillation. Both European and American guidelines highlight weight loss and treatment of obesity as an important part of reducing the risk of atrial fibrillation.
Alcohol – this is another common and sometimes underestimated factor. Some people experience palpitations after even moderate amounts, while others only notice problems after they have reached a high consumption or after periods of more intensive drinking. Alcohol can directly affect the heart's electrical signaling and at the same time impair sleep, blood pressure and recovery.
Smoking – Smoking is also mentioned in the international guidelines as a factor to address. Smoking damages blood vessels and increases cardiovascular risk and often interacts with other conditions such as high blood pressure and lung disease.
It is relatively common for reality to look like this: you have slightly elevated blood pressure, are a few pounds overweight, snore a lot and drink alcohol on the weekends – without feeling “sick”. All of these factors can together contribute to an increased risk over time. That is why one can be valuable even when you feel relatively well.
Other diseases that can cause or trigger atrial fibrillation
Atrial fibrillation often does not occur in isolation, it is a condition that often interacts with other diseases.
Common underlying conditions are:
Coronary artery disease
Valvular disease
Lung disease
Sleep apnea
Overactive thyroid (hyperthyroidism)
Can stress cause atrial fibrillation?
The answer is that stress itself is rarely the only root cause, but it can act as a trigger in people who already have a vulnerability. The same applies to infection, fever, dehydration, lack of sleep and disturbances in the body's salts and minerals, so-called electrolytes. If potassium, magnesium or other electrolytes are out of balance, the heart's conduction system can be affected. Certain medications, supplements and stimulants can also contribute in sensitive people.
Sleep apnea - often an undertreated cardiovascular risk factor
This is a condition that deserves special attention. In obstructive sleep apnea, breathing stops repeatedly during sleep. This then leads to a lack of oxygen, stress in the body, increased blood pressure and increased strain on the heart. The American Heart Association has highlighted sleep apnea as an important and often undertreated cardiovascular risk factor, and screening is especially recommended in people with difficult-to-treat blood pressure or recurrent atrial fibrillation.
Hyperthyroidism – a classic example of a treatable cause
A classic example of a treatable cause of atrial fibrillation is an overactive thyroid gland (hyperthyroidism). If you have a high metabolism, the heart becomes more irritable and the heart rate increases, which can trigger atrial fibrillation. Therefore, testing for thyroid values is often included in the investigation.
Symptoms and warning signs
Atrial fibrillation can feel very different from person to person.
Common symptoms are:
palpitations or irregular heartbeats
rapid pulse
shortness of breath
fatigue or decreased energy
dizziness
chest discomfort
reduced performance during exercise or work
Warning signs
It is also important to know that atrial fibrillation can also be completely asymptomatic. Some people only discover it when their blood pressure is checked, their pulse feels irregular, when an ECG is taken before surgery, an occupational health check or when investigating a stroke.
What can you do yourself - and when should you test your values?
The most effective preventive work is often about identifying what can be influenced early on. If you want to reduce your risk of atrial fibrillation, or have already been diagnosed, the following is particularly important:
control and treat high blood pressure
work on weight loss if you are overweight or obese
limit alcohol
quit smoking
treat diabetes, thyroid disease and other underlying diseases
pay attention to symptoms of sleep apnea, such as snoring, breathing pauses and pronounced daytime fatigue
prioritize regular physical activity and good sleep
Samples and health checks alone cannot make the diagnosis – an ECG or rhythm recording is usually needed – but they can help to detect several of the underlying risk factors, such as blood pressure, blood sugar, blood lipids, kidney values and thyroid tests.
It may be especially wise for people with fatigue, palpitations, high blood pressure or a history of cardiovascular disease to have a health check that also includes an ECG.
Knowing the risk factors and causes of atrial fibrillation is not just about understanding a diagnosis, but about having the opportunity to influence your future heart health. The earlier you find stress factors, the greater the chance of preventing complications.
