Does Lifestyle Impact Risk, Burden and Symptomatology of Atrial Fibrillation?

Main Article Content

Ratika Parkash


Lifestyle Impact Risk, Burden Symptomatology Atrial Fibrillation


Atrial fibrillation is the most common sustained arrhythmia, affecting 1-2% of the general population and 8% of patients over the age of 80 years.  The lifetime risk for development of AF is 26% for men and 23% for women.  It is associated with significant morbidity, mortality and cost, but also with an increase in mortality and a six-fold risk of stroke.  The Framingham heart study showed that AF was associated with a 1.5 to1.9 fold mortality risk after adjustment for the preexisting CV conditions with which AF was related. The Heart and Stroke Foundation estimates that 350 000 Canadians are living with atrial fibrillation, and that this is increasing due to Canada’s aging population.  

Abstract 21 | pdf Downloads 17 HTML Downloads 4


1. Lip GY, Tse HF. Management of atrial fibrillation. Lancet 2007;370:604-618.
2. Lip GY, Tse HF. Management of atrial fibrillation. Lancet 2007;370:604-18.
3. Wolf PA, Dawber TR, Thomas HE, Jr., Kannel WB. Epidemiologic assessment of chronic atrial fibrillation and risk of stroke: the Framingham study. Neurology 1978;28:973-977.
4. Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation: a major contributor to stroke in the elderly. The Framingham Study. ArchInternMed 1987;147:1561-1564.
5. Benjamin EJ, Wolf PA, D'Agostino RB, Silbershatz H, Kannel WB, Levy D. Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. Circulation 1998;98:946-52.
6. Stroke. Heart and Stroke Foundation of Canada 2013.
7. Parkash R, Maisel WH, Toca FM, Stevenson WG. Atrial fibrillation in heart failure: high mortality risk even if ventricular function is preserved. AmHeart J 2005;150:701-706.
8. Kirchhof P, Schmalowsky J, Pittrow D et al. Management of patients with atrial fibrillation by primary-care physicians in Germany: 1-year results of the ATRIUM registry. Clin Cardiol 2014;37:277-84.
9. Wolf PA, Mitchell JB, Baker CS, Kannel WB, D'Agostino RB. Impact of atrial fibrillation on mortality, stroke, and medical costs. Arch Intern Med 1998;158:229-34.
10. McDonald AJ, Pelletier AJ, Ellinor PT, Camargo CA, Jr. Increasing US emergency department visit rates and subsequent hospital admissions for atrial fibrillation from 1993 to 2004. AnnEmergMed 2008;51:58-65.
11. Khaykin Y, Morillo CA, Skanes AC, McCracken A, Humphries K, Kerr CR. Cost comparison of catheter ablation and medical therapy in atrial fibrillation. Journal of cardiovascular electrophysiology 2007;18:907-13.
12. Gladstone DJ, Bui E, Fang J et al. Potentially preventable strokes in high-risk patients with atrial fibrillation who are not adequately anticoagulated. Stroke 2009;40:235-240.
13. Ogilvie IM, Newton N, Welner SA, Cowell W, Lip GY. Underuse of oral anticoagulants in atrial fibrillation: a systematic review. Am J Med 2010;123:638-645.
14. Nattel S. New ideas about atrial fibrillation 50 years on. Nature 2002;415:219-226.
15. Haissaguerre M, Jais P, Shah DC et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med 1998;339:659-666.
16. Dixit S, Marchlinski FE, Lin D et al. Randomized ablation strategies for the treatment of persistent atrial fibrillation: RASTA study. Circ Arrhythm Electrophysiol 2012;5:287-94.
17. Saygili E, Rana OR, Saygili E et al. Losartan prevents stretch-induced electrical remodeling in cultured atrial neonatal myocytes. Am J Physiol Heart Circ Physiol 2007;292:H2898-H2905.
18. Wijffels MC, Kirchhof CJ, Dorland R, Allessie MA. Atrial fibrillation begets atrial fibrillation. A study in awake chronically instrumented goats. Circulation 1995;92:1954-1968.
19. Scherlag BJ, Patterson E, Po SS. The neural basis of atrial fibrillation. J Electrocardiol 2006.
20. Kistler PM, Sanders P, Dodic M et al. Atrial electrical and structural abnormalities in an ovine model of chronic blood pressure elevation after prenatal corticosteroid exposure: implications for development of atrial fibrillation. Eur Heart J 2006;27:3045-3056.
21. Anter E, Di Biase L, Contreras-Valdes FM et al. Atrial Substrate and Triggers of Paroxysmal Atrial Fibrillation in Patients With Obstructive Sleep Apnea. Circ Arrhythm Electrophysiol 2017;10.
22. Gillis AM, Verma A, Talajic M, Nattel S, Dorian P. Canadian cardiovascular society atrial fibrillation guidelines 2010: rate and rhythm management. CanJCardiol 2011;27:47-59.
23. Cairns JA, Connolly S, McMurtry S, Stephenson M, Talajic M. Canadian cardiovascular society atrial fibrillation guidelines 2010: prevention of stroke and systemic thromboembolism in atrial fibrillation and flutter. CanJCardiol 2011;27:74-90.
24. Healey JS, Parkash R, Pollak PT, Tsang TS, Dorian P. Canadian Cardiovascular Society 2010 Atrial Fibrillation Guidelines: Chapter 2 - Atrial Fibrillation: Etiology and Initial Investigations. CanJCardiol 2011.
25. Wyse DG, Van Gelder IC, Ellinor PT et al. Lone atrial fibrillation: does it exist? J Am Coll Cardiol 2014;63:1715-23.
26. Schnabel RB, Yin X, Gona P et al. 50 year trends in atrial fibrillation prevalence, incidence, risk factors, and mortality in the Framingham Heart Study: a cohort study. Lancet 2015;386:154-62.
27. Staerk L, Wang B, Preis SR et al. Lifetime risk of atrial fibrillation according to optimal, borderline, or elevated levels of risk factors: cohort study based on longitudinal data from the Framingham Heart Study. BMJ 2018;361:k1453.
28. Van Wagoner DR, Piccini JP, Albert CM et al. Progress toward the prevention and treatment of atrial fibrillation: A summary of the Heart Rhythm Society Research Forum on the Treatment and Prevention of Atrial Fibrillation, Washington, DC, December 9-10, 2013. Heart Rhythm 2015;12:e5-e29.
29. Belardinelli R, Georgiou D, Ginzton L, Cianci G, Purcaro A. Effects of moderate exercise training on thallium uptake and contractile response to low-dose dobutamine of dysfunctional myocardium in patients with ischemic cardiomyopathy. Circulation 1998;97:553-561.
30. Osbak PS, Mourier M, Kjaer A, Henriksen JH, Kofoed KF, Jensen GB. A randomized study of the effects of exercise training on patients with atrial fibrillation. AmHeart J 2011;162:1080-1087.
31. Reed JL, Mark AE, Reid RD, Pipe AL. The effects of chronic exercise training in individuals with permanent atrial fibrillation: a systematic review. CanJCardiol 2013;29:1721-1728.
32. Giacomantonio NB, Bredin SS, Foulds HJ, Warburton DE. A systematic review of the health benefits of exercise rehabilitation in persons living with atrial fibrillation. CanJCardiol 2013;29:483-491.
33. !!! INVALID CITATION !!! (38).
34. !!! INVALID CITATION !!! (39).
35. !!! INVALID CITATION !!! (34).
36. Abed HS, Wittert GA, Leong DP et al. Effect of weight reduction and cardiometabolic risk factor management on symptom burden and severity in patients with atrial fibrillation: a randomized clinical trial. JAMA 2013;310:2050-2060.
37. Rienstra M, Hobbelt AH, Alings M et al. Targeted therapy of underlying conditions improves sinus rhythm maintenance in patients with persistent atrial fibrillation: results of the RACE 3 trial. Eur Heart J 2018.
38. !!! INVALID CITATION !!! (35).
39. !!! INVALID CITATION !!! (37).
40. Parkash R, Verma A, Tang AS. Persistent atrial fibrillation: current approach and controversies. Curr Opin Cardiol 2010;25:1-7.
41. Healey JS, Connolly SJ. Atrial fibrillation: hypertension as a causative agent, risk factor for complications, and potential therapeutic target. Am J Cardiol 2003;91:9G-14G.
42. Kannel WB, Wolf PA, Benjamin EJ, Levy D. Prevalence, incidence, prognosis, and predisposing conditions for atrial fibrillation: population-based estimates. Am J Cardiol 1998;82:2N-9N.
43. Conen D, Tedrow UB, Koplan BA, Glynn RJ, Buring JE, Albert CM. Influence of systolic and diastolic blood pressure on the risk of incident atrial fibrillation in women. Circulation 2009;119:2146-2152.
44. Wachtell K, Lehto M, Gerdts E et al. Angiotensin II receptor blockade reduces new-onset atrial fibrillation and subsequent stroke compared to atenolol: the Losartan Intervention For End Point Reduction in Hypertension (LIFE) study. J Am Coll Cardiol 2005;45:712-719.
45. Healey JS, Baranchuk A, Crystal E et al. Prevention of atrial fibrillation with angiotensin-converting enzyme inhibitors and angiotensin receptor blockers: a meta-analysis. J Am Coll Cardiol 2005;45:1832-1839.
46. Disertori M, Latini R, Barlera S et al. Valsartan for prevention of recurrent atrial fibrillation. N Engl J Med 2009;360:1606-1617.
47. Yusuf S, Healey JS, Pogue J et al. Irbesartan in patients with atrial fibrillation. N Engl J Med 2011;364:928-38.
48. !!! INVALID CITATION !!! (40).
49. Leung AA, Daskalopoulou SS, Dasgupta K et al. Hypertension Canada's 2017 Guidelines for Diagnosis, Risk Assessment, Prevention, and Treatment of Hypertension in Adults. Can J Cardiol 2017;33:557-576.
50. Holmqvist F, Guan N, Zhu Z et al. Impact of obstructive sleep apnea and continuous positive airway pressure therapy on outcomes in patients with atrial fibrillation-Results from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF). American heart journal 2015;169:647-654 e2.
51. Li L, Wang ZW, Li J et al. Efficacy of catheter ablation of atrial fibrillation in patients with obstructive sleep apnoea with and without continuous positive airway pressure treatment: a meta-analysis of observational studies. Europace 2014;16:1309-14.
52. McEvoy RD, Antic NA, Heeley E et al. CPAP for Prevention of Cardiovascular Events in Obstructive Sleep Apnea. N Engl J Med 2016;375:919-31.
53. !!! INVALID CITATION !!! (36).
54. !!! INVALID CITATION !!! (41).
55. Carter L, Gardner M, Magee K et al. An Integrated Management Approach to Atrial Fibrillation. J AmHeart Assoc 2016;5.
56. !!! INVALID CITATION !!! (7).
57. Gross PA, Patriaco D, McGuire K, Skurnick J, Teichholz LE. A nurse practitioner intervention model to maximize efficient use of telemetry resources. Jt Comm J Qual Improv 2002;28:566-573.
58. Shelton RJ, Allinson A, Johnson T, Smales C, Kaye GC. Four years experience of a nurse-led elective cardioversion service within a district general hospital setting. Europace 2006;8:81-85.
59. Boodhoo L, Bordoli G, Mitchell AR, Lloyd G, Sulke N, Patel N. The safety and effectiveness of a nurse led cardioversion service under sedation. Heart 2004;90:1443-1446.
60. Andersen MK, Markenvard JD, Schjott H, Nielsen HL, Gustafsson F. Effects of a nurse-based heart failure clinic on drug utilization and admissions in a community hospital setting. Scand Cardiovasc J 2005;39:199-205.
61. Andersson B, Kjork E, Brunlof G. Temporal improvement in heart failure survival related to the use of a nurse-directed clinic and recommended pharmacological treatment. Int J Cardiol 2005;104:257-263.
62. !!! INVALID CITATION !!! (13, 14).