Medical myth-busters: The facts about atrial fibrillation

Atrial fibrillation (AFib) contributes to more than 454,000 hospitalizations and 158,000 deaths every year in the United States. And, according to the CDC, AFib mortality has been rising for the past 2 decades. Even so, it’s likely that many of your patients—possibly even your physician colleagues—are unaware of the condition’s risk factors, symptoms, and consequences.

AFib is the most common type of heart arrhythmia that occurs when the beating of the heart’s upper chambers is out of sync with the lower chambers. This can cause an irregular or very rapid heart rate in the moment, and over time can increase the risk of blood clots, stroke, heart failure, and other adverse outcomes.

AFib episodes may flare up irregularly or consistently. Whatever the case, it’s a serious medical condition that should always be treated or managed in order to reduce stroke risk. Treatments include anti-clotting and heart-rhythm controlling medication, cardioversion therapy, or catheter procedures. 

Despite the condition’s increasing prevalence, few know that as little as 1 alcoholic drink a day can increase risk of AFib or trigger an event—or that cardioversion isn’t a permanent cure. 

For the sake of managing patients’ misconceptions, let’s bust six AFib myths with evidence from recent studies and expert health advice. 

Myth #1: AFib is curable 

According to the Cleveland Clinic, AFib cannot be cured. Medication can relieve symptoms by decreasing the number of AFib episodes, but drugs tend to become less effective over time. Catheter ablation or surgery, while not a cure, is the most effective symptom-reliever available, but AFib episodes may still occur afterward.

Stress, sleep apnea, smoking, caffeinated beverages, and other stimulants can all trigger episodes. Conditions like high blood pressure and coronary artery disease can also lead to AFib, and in these cases, managing those conditions is imperative.

Myth #2: Cardioversion will stop future AFib episodes 

Electrical cardioversion is a technique that involves “shocking” the heart into a normal rhythm, but, as with the treatments above, it won’t stop all future episodes. Medication and/or ablation may also be required on top of cardioversion. 

Drugs that may be required following ablation include beta-blockers, anti-arrhythmic drugs, and anticoagulants. In some cases, a pacemaker may also be installed to address a slower-than-average heart rate that can result from these medications. Cardioversion is effective roughly 75% of the time, but the procedure often has to be repeated when AFib episodes resume. 

Myth #3: Treatment isn’t required for sporadic AFib episodes

AFib is a recurring condition, and lifelong treatment is almost always required to avoid more serious complications like heart failure or stroke. When a patient begins to experience AFib episodes, they can be infrequent (this is known as paroxysmal atrial fibrillation). But over time, episodes typically become more frequent and longer in duration. In fact, up to 30% of AFib cases are asymptomatic—but treatment is still important to prevent further complications. 

Myth #4: Drinking in moderation is OK for AFib patients  

While much health advice states that patients should only drink in moderation if they have AFib, a study published in the European Heart Journal in January of this year concluded that any level of drinking is a bad idea for these patients.

Researchers examined a cohort of 107,845 participants to explore the association between alcohol consumption and incident AFib. They found that, unlike cardiovascular diseases like heart failure, even modest alcohol consumption was associated with increased risk of AFib. In fact, researchers noted that as little as 1.2 alcoholic drinks per day appeared to correlate with increased incidence of AFib episodes. 

The study adds to a growing body of research supporting teetotaling to mitigate AFib, including a study published in NEJM in January 2020, which concluded “abstinence from alcohol reduced arrhythmia recurrences in regular drinkers with atrial fibrillation.”

Myth #5: If catheter ablation is successful, medications can be stopped

This may be true in some cases, but according to the Cleveland Clinic, patients may need to continue medications based on risk factors for stroke or other possible complications. Similarly, more than one catheter ablation procedure may be required to interrupt faulty electrical pathways in the heart. 

While the success rate for ablation sits between 70%-80%, this increases to 90% after a second or third procedure.

Myth #6: Physical activity (including sex) is a risk factor for AFib 

While it may feel counter-intuitive, research has shown that there is no association between regular physical activity and increased incidence of atrial fibrillation, according to an article published by The American Journal of Medicine. Some studies even indicate that there is an inverse association between time spent on leisure activities and risk of AFib. While high-intensity exercise may not be a good idea, moderate exercise offers patients with AFib all the usual benefits. 

Likewise, sexual intercourse is a heart-healthy form of exercise that can ease stress, and is typically a boost to the health of AFib patients, according to a WebMD article.