Alcohol consumption, coffee drinking, exercise and lack of sleep are frequently reported triggers for atrial fibrillation, or AFib, the most common heart rhythm disorder (arrhythmia).
Consuming cold beverages or cold food, eating large meals, being dehydrated and lying on the left side are also on the list of reported behaviours that set off the arrythmia.
Yet few studies have evaluated the effect of presumed triggers on isolated episodes of atrial fibrillation.
Now, new research from the University of California, San Francisco (UCSF)has found that among the possible triggers, only alcohol use was consistently related to increased episodes.
What is atrial fibrillation?
During atrial fibrillation, also called AFib, electrical signal disturbances cause the heart’s upper two chambers (the atria) to beat irregularly, or quiver. As a result, the heart may not pump enough blood to the lungs and body.
Symptoms can include a racing or pounding heartbeat, dizziness, sweating, shortness of breath, weakness and fatigue. Sometimes, though, AFib doesn’t cause any symptoms.
AFib episodes can come and go, called paroxysmal atrial fibrillation, or they can be persistent or permanent. Having atrial fibrillation increase the risk of blood clots, stroke and heart failure.
Risk factors include advancing age, hypertension, sleep apnea, heart disease, obesity and heavy alcohol use. Family history, prehypertension, diabetes, smoking and inflammation are also thought to increase the risk of AFib.
About the study
The I-STOP-AFib trial, published online earlier this month in JAMA Cardiology, investigated the effect of presumed triggers on arrythmia in 466 individuals with paroxysmal atrial fibrillation. (I-STOP-AFib stands for Individualized Studies of Triggers of Paroxysmal Atrial Fibrillation.)
For the study, 466 participants were given a mobile electrocardiogram (ECG) recording device which pairs with smartphones. They were instructed to use the device daily and whenever they had symptoms of AFib.
Participants were then assigned to either an individualized trigger-testing arm or an AFib monitoring-only arm. Those in the testing arm were asked to choose a trigger they wanted to test from a menu of triggers commonly reported by patients. They used a phone app to log potential triggers like drinking alcohol and caffeine, sleeping on the left side or not getting enough sleep, eating a large meal, a cold drink, or sticking to a particular diet, engaging in exercise, or anything else they thought was relevant to their AFib.'
The researchers found that only alcohol use was consistently associated with more episodes of the heart arrhythmia.
Although caffeine was the most commonly selected trigger for testing, they found no evidence of a near-term relationship between caffeine consumption and atrial fibrillation. Recent research from UCSF had similarly failed to demonstrate a relationship between caffeine and arrhythmias -- on the contrary, investigators found it may have a protective effect.
The individualized testing method, known as n-of-1, did not validate participant-selected triggers for AF. But trial participants did report fewer AF episodes than those in the control group, and the data suggest that behaviors like avoiding alcohol could lessen the chances of having an AF episode.
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