Atrial fibrillation: New guidelines, new advice

Atrial fibrillation, or afib, causes a rapid, irregular heartbeat that can come and go without warning. Electrical misfires make the heart's upper chambers (atria) quiver instead of contracting normally. While people often notice a fluttering, pounding sensation in their chests and may become lightheaded, dizzy, and breathless, many feel no symptoms.

Importantly, afib significantly increases the risk of stroke, especially in older adults. That's because those irregular contractions may allow blood to pool in the atria and form clots. If a clot travels to your brain, it can cause a stroke. An estimated one in 11 people age 65 and older live with higher stroke risk due to afib –– possibly even you.

Fortunately, new guidelines published last year in the journal Circulation emphasize everyday habits that can help prevent or slow the progression of afib. "There are many things you can do to lower your risk," says Dr. Moussa Mansour, professor at Harvard Medical School and director of the Atrial Fibrillation Program at Massachusetts General Hospital. Here are four key takeaways:

1. Alcohol and caffeine

• Alcohol is a major risk factor for afib. There's no set "safe" amount, but the less you drink, the better. The guidelines suggest no more than one drink per day, but even that may be too much for some.
• Caffeine may trigger palpitations in sensitive individuals. However, moderate coffee consumption (1–3 cups per day) is not linked to a higher risk of afib-according to the guidelines, it may even be protective.

2. Weight

• Obesity (BMI of 30 or more) is strongly linked to afib. It raises blood pressure, increases the risk of sleep apnea, and adds fat around the heart, promoting inflammation and structural changes. The recommendation: aim for a BMI of 27 or lower. Even losing 10% of your body weight can help reduce afib episodes and improve treatment outcomes.

3. Exercise

• Regular exercise helps manage weight and reduce afib burden (how often and how long episodes last). The guidelines recommend 210 minutes per week (30 minutes daily) of moderate to vigorous activity.
• Dr. Mansour offers simple advice: "Aim for 3 to 4 hours of exercise every week, at a level of effort that's more than a casual walk," he says. Depending on how active you are, you may need to work up to this slowly, adding minutes week by week.

4. Sleep and snoring

• Sleep apnea is common in people with afib. If you snore or often feel sleepy during the day, get evaluated. Treating sleep apnea can reduce the risk of developing atrial fibrillation and make it easier to manage if you already have it.

Bottom Line: Healthy lifestyle choices-less alcohol, regular activity, better sleep, and modest weight loss-play a large role in both preventing afib episodes and making them easier to control when they do occur.

For more information on treating or preventing atrial fibrillation, read Managing Atrial Fibrillation, an Online Guide from Harvard Medical School.

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