Atrial Fibrillation: Prevention

Prevention of atrial fibrillation (AF) requires attention to reducing individual risk factors. Behavioral risk factors

  • Diet
    • Opulent meal (sumptuous food)
    • Micronutrient deficiency (vital substances) – see Prevention with micronutrients.
  • Consumption of stimulants
    • Alcohol (woman: > 15 g/day; man: > 20 g/day)
      • Holiday heart syndrome: alcohol-induced arrhythmia]; significant dose-dependent deterioration in left ventricular function after alcohol (ejection fraction (EF): reduction from an average of 58% to an average of 52%; in healthy individuals: to 50-60%.
      • Increase in VCF as a function of alcohol dose.
    • Tobacco (smoking)
      • Also passive smoking during childhood: 14.3% developed atrial fibrillation (VHF) a mean of 40.5 years after reaching adulthood; passing on the smoking habit to children resulted in a 34% increased risk of developing VHF in them
    • Energy drinks (containing 400 mg/100 ml taurine and 32 mg/100 ml caffeine) – significant prolongations of the QTc interval and increase in systolic blood pressure.
  • Physical activity
    • Physical inactivity
    • Physical overload
    • Competitive sports
      • VHF is more common in competitive “middle-aged and older endurance athletes with long training history” (51 ± 9 years), probably because of left atrial overstretching; the higher the training intensity, the higher the VHF risk
      • Strength-based competitive sports such as American football – former National Football League (NFL) players were 6 times more likely to suffer from VCF than men in a population-based control group
  • Psycho-social situation
    • Trouble
    • Emotional stress
    • Frequent sleep deprivation/poor sleep quality (insomnia/sleep disorder).
    • Bereavement (41% increased risk of VCF 30 days after bereavement; 1.34-fold increased risk for those under 60 years of age)
    • Weekly work hours > 55 hours (1.4-fold increased risk).
  • Overweight (BMI ≥ 25; obesity).
    • Excessive body mass index (BMI) was responsible for approximately 20% of cases with VCF:
      • BMI in men: 31% increased risk.
      • BMI in women: 18% increased risk

Environmental pollution – intoxications (poisonings).

  • Noise
  • Low temperatures

Other risk factors

  • Acute alcohol intoxication (alcohol poisoning).
  • After surgical procedures, especially cardiac surgery, atrial fibrillation is a common complication; it is more common in mitral valve procedures (up to 73%) than in bypass surgery (10-33%)

Prevention factors (protective factors)

  • Genetic factors:
    • Genetic risk reduction depending on gene polymorphisms:
      • Genes/SNPs (single nucleotide polymorphism; English : single nucleotide polymorphism):
        • Gene: LOC729065
        • SNP: rs10033464 in an intergenic region.
          • Allele constellation: GG (0.92-fold).
        • SNP: rs2200733 in gene LOC729065
          • Allele constellation: CC (0.86-fold).
  • Chocolate (dark chocolate) due toflavanols from the cocoa beans.
  • Physical activity:
    • To prevent atrial fibrillation, light to moderately strenuous activities such as running, golfing, and gardening seem appropriate.
    • Physically active women have a lower risk of atrial fibrillation than physically active men (hazard ratio [HR] for 1500 vs 0 MET-min/week: 0.85 for women vs 0.90 for men); this is true for exercise-active women at weekly activity volumes of up to 2. 500 MET-min/week (MET stands for metabolic equivalent; 600 MET-min is achieved by about 150 minutes of brisk walking or 75 minutes of running); men, on the other hand, had a low risk only up to an activity volume of about 2,000 MET-min/week; when exceeded, this was already associated with an increased risk of AF.

Secondary prevention

  • Alcohol abstinence (abstaining from alcohol): significantly reduces number and duration of arrhythmias.In the abstinence group, 37 of 70 patients (53%) experienced at least one recurrence of AF compared with 51 of 70 patients (73%) in the control group
  • Beta-blockers protect against stress-induced atrial fibrillation: While stress and anger significantly increased the risk of AF (odds ratio 22.5), the effect was much smaller in patients taking beta-blockers, with an odds ratio of 4.0.

Operative Prophylaxis:

  • Stent implantations in the carotids.
  • Occlusion of the left atrial appendage (LAA) – more than 90% of thromboembolism in nonvalvular atrial fibrillation originates from the left atrial appendage
  • Closure of the persistent foramen ovale (PFO); this allows a cardiac right-to-left shunt at the atrial level; incidence: approximately 25% of all people; three studies show that PFO closure leads to a significant reduction in recurrent ischemic stroke:
    • CLOSE:
      • Significant reduction in recurrent ischemic stroke.
        • Compared to platelet inhibition alone (hazard ratio: 0.03, p < 0.001).
        • In the oral anticoagulation group, the rate of stroke recurrence was about half that with antiplatelet prophylaxis (3 vs.7 events; HR 0.43)
    • GoreREduce:
      • In the group with PFO closure, ischemic stroke recurrences were registered in six patients (1.4%) and in 12 patients (5.4%) in the group with platelet inhibition alone (= significant relative risk reduction of 77% corresponds to (HR 0.23, p=0.002))
    • RESPECT:
      • Risk of any ischemic stroke recurrence was relatively reduced by 45% with PFO closure (18 vs. 28 events; HR 0.55, p=0.046)