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Atrial fibrillation

What causes atrial fibrillation?

No-one can be sure what causes atrial fibrillation (AF). There are some factors, however, which may make people more susceptible.
 

Dr Tim Holt explains why some people might be more likely to get AF.

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Atrial fibrillation is particularly associated with getting older so that, you know, age is a particularly strong risk factor for atrial fibrillation. People are more likely also to get it if they have anything else affecting their heart, particularly coronary heart disease, and also people with hypertension, in the long run, are more likely to develop atrial fibrillation. People who have damaged the heart for other reasons including alcohol, too much alcohol in their lives are more likely and then there are other causes including thyroid conditions which can raise the risk. So there are a number of medical conditions, which can add to any sort of genetic predisposition to increase an individual’s risk.
Yet, making sense of their diagnosis and identifying possible causes is important for many people. Elisabeth Y and Marianne believe that stress associated with the death of their husbands, ‘grief in its own country’, may have initiated their AF. Stress, anxiety, high blood pressure and a family history of heart problems were widely mentioned, with people often attributing their AF to more than one cause. Eileen is unsure what has triggered her AF but thinks it might be stress, although high blood pressure and a family history of AF and strokes could suggest a ‘genetic possibility as well’.
 

George Y believes years of anxiety may have contributed to his AF.

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Age at interview: 66
Sex: Male
Age at diagnosis: 58
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I would say, my GP says that it is what he would call, and he has been my GP this last thirty forty years so he knows me well enough, and he’s seen he’s seen my progression in life, it’s an anxiety problem that I have, have had, and will have, and that contributes to the AF trigger or the reason that I had it. It could be that it’s just like an elastic band, too much tension and then it [pings dum dum dum dum] goes off, or something suddenly comes. Now there are times, if somebody came through that door now I may jump [aaaargh] like that. That just, the tension is always under surface but not recognisable until something happens.

So there is that tension. I’m not denying it and it would contribute, I know it would contribute and, of course, if I feel something on my heart, and it’s only a murmur or a or an irregularity flicker, I go into worry mode or danger mode or anything like that and, therefore, if it had half an idea of coming it’s going to come that actual wee bit maybe because of that. So I would say, yes, that that does have a contributory factor.
 

Freda suspects that she might have inherited AF from her mother.

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Age at interview: 70
Sex: Female
Age at diagnosis: 68
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I knew I was quite healthy, so I was quite puzzled why I had this sudden palpitation. Then I suddenly remembered that when I was a teenager I was about fifteen, sixteen, when I came home my mother would be in the sitting (room) and doing needlework or something like that, then I would chat to her and various things that happened at school and she would suddenly say, “Oh, I’ve got my heartbeating. I wonder what this is.” You know, I clearly remember that moment. Of course, I since I’ve got married I had been away from my mother. I have never noted that she complained of heartbeat but she complained of funny head. She didn’t say it was a headache but light hearted head and that she occasionally, when I visited her, I mean to say, in recent years, that she complained about, “Today, it’s my bad day. I’ve got funny head. You know, giddy and I can’t really keep standing up.” And things like that and precisely, this that symptom I began to have together with this heartbeat after two years or so, 2000, later 2010, I began to have this symptom. I had no idea that it was, I have no idea that this is anything to do with my heartbeat or the condition of my heart but that’s one query I have but the GP, GPs are not able to help me understand what’s happening to my body. 

Perhaps I have inherited something of my mother, which obviously, started in her in her late life or middle to later late life. By the way my mother survived to live to age of 102. So she was, in a way, healthy. 
As well as high blood pressure, people also suggested other possible health links, including a history of mitral valve disease, reflux from a hiatus hernia, and an electrolyte imbalance. Chris X had heard theories about electrical defects and the shape of the heart wall, and suggested that endurance athletes can sometimes develop AF. Paul had trained in the military when he was younger, and had recently decided to train for a marathon. He wondered whether he had pushed his body too far and triggered AF.
 

Gail researched possible causes and found a tenuous link with scuba diving.

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Age at interview: 62
Sex: Female
Age at diagnosis: 44
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I did find out, when I first had it and, as I mentioned, it happened when I’d been scuba diving and I did a little bit of reading around about then, and found out that it was common in, there’s some particular group of women in some country in South East Asia, who free dive for scallops or fish or something, who get it [laughs]. So it seems to be something that might be associated with, you know, it happening in physically fit people who happen to dive, so women but no, I’ve no theories about why it’s happened to me.
 

Pauline thought her AF might be linked to indigestion or to summer heat.

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Age at interview: 69
Sex: Female
Age at diagnosis: 65
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I’m sure it is linked to the indigestion and this nerve from the stomach. I’m sure it is. I can’t think that I was particularly stressed at that time. It was both times in the summer. Whether the heat has anything to do with it. There could be a question mark there and I am always better in the winter, not better but I’m a winter person. I flag, I wilt [laughs] in the summer. I’m not a not a heat person at all. So maybe that was something to do with it but big question mark there really. 
Some people linked their AF to other health conditions, including the ‘vagal nervous system’ being out of balance and associated digestive issues, such as irritable bowel syndrome (IBS). Freda found that a lack of sleep affected her AF and that she had symptoms when her mind was ‘not active’. Anne had an enlarged heart due to another condition and wondered whether that had contributed to her developing AF. Dot said she did not know why her AF had started but was just ‘very annoyed about it’. Richard was told his AF might have been caused by rheumatic fever as a child, though he believes this is unlikely.
 

George Y had a mixed response from his doctors when he wondered whether his AF was related to his glaucoma and a deep vein thrombosis (DVT).

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Age at interview: 66
Sex: Male
Age at diagnosis: 58
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I asked him, “Where did this come from? What started it? What could have happened?” And he, without saying it all with the one breath, but with one way or another, he said that the DVT could have had a contributing factor towards this initiating later and it happened, as I say, about eleven months after the DVT was in my leg.

But I was speaking to other eye people and they have said that there could be a relationship between glaucoma and AF. They in in their studies, they had come across some study that there may be some connection between one and the other. I know that whenever you go to the optician or the ophthalmologist, who gets your eyes, the new thing now is to get your eyes photographed and then they’re able to look at it and they’re able to see why your blood pressure or there’s a pressure and all this. So there maybe something, if it’s to do with blood pressure in there, you know, I don’t know. But they weren’t, some people were in doubt and said they’d never heard of that. “Oh I never heard of any connection between glaucoma and AF, no, no.” But one person said “Yes” and that’s the one person I’m mentioning in the sense that they said that they did hear it. All the other ones never said it but it could be that they mightn’t be that au fait with AF to know, you know, one way or another because these were just. It the acute is very rare. My mother had it. My brother, my uncle had it and my grandfather had it and they went blind with it.
 

Carin thought initially that problems with her thyroid and having her goitre removed may have started her AF, but no longer believes this.

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Age at interview: 62
Sex: Female
Age at diagnosis: 55
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Well, it the consultant came the next morning and said, well, it was atrial fibrillation and he said, “It’s very strange” he says, “Because you’re very young to get that.” And I was sort of in my mid-fifties or whatever, fifty five or so, and very young to get that, and then I had an undiagnosed goitre, at the time, thyroid and so they, that’s what they discarded that because, and they felt it and they said, “Oh, you have you have, yeah, you have a thyroid problem at the same time.” So, you know, they connected the two things then, but that that’s not turned out to be the reason I think, because now I haven’t got that thyroid anymore. I’m taking of course, I’m taking thyroxin, which my endocrinologist said it was, that may have been the reason for me sparking off into this continuous atrial fib from as from half a year ago. But I don’t think that was the reason anymore, because I’ve lowered my thyroxin now and then nothing, you know. It’s just there.
Some people found that their AF started after an operation and wonder whether there was a link. Jeni linked her AF to an operation on her womb, despite being reassured at the time that there was nothing wrong: ‘it’s quite common after surgery on the womb that women have palpitation attacks’.
 

Glyn suspects a link between anaesthetics and AF. He believes an operation for a burst appendix may have triggered his AF.

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Age at interview: 64
Sex: Male
Age at diagnosis: 56
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I think that there was a definite link because it shows that maybe, some people’s cases, when you have what happens, when you have an operation and you have anaesthetic, with the anaesthetic is adrenalin, that’s right, I couldn’t think of it. You get adrenalin pumped into you as well. So when you when you recover from the operation, that adrenalin wakes you up. Now it may start off as well, it may start your heart racing so I think that’s something to do with it but as I say, when I, before I had the operation, I explained that, before I had my hernia operation as well, I explained that to the doctor and he said, “No, you’ll be fine, [name]. You’ll be fine.” But, of course, he didn’t realise that I’d probably had it back in nineteen ninety after my burst appendix, so perhaps he didn’t realise that anaesthetic or adrenalin that actually starts off AF. Another thing is as well, I mentioned it too, is that too much adrenalin in your body can cause you to have AF. Too much anxiety, depression in your body can cause you to have AF. So, you know, it’s a lot of a lot of things could start you having AF, you know, without you even thinking about it, you know.
Alcohol, smoking, coffee and being overweight were also suggested as possible causes of AF. As Nuala said, ‘I know that alcohol can have a big impact - when I look back on it now, I probably was taking far too much but I wasn’t aware of it at the time’. Dave, who has not had any alcohol for ‘nearly eighteen years’, accepts his consultant’s opinion that excess alcohol in the past may have contributed to his AF. Keith has now quit smoking but believes there may be a link between being a smoker in the past and his AF.
 

For a short time, Paul had fewer episodes of AF after he lost weight and stopped drinking alcohol and coffee. He was disappointed, however, when his AF became permanent.

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Age at interview: 57
Sex: Male
Age at diagnosis: 55
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It was me who made the choices after reading in depth a little bit on the on the web and literature provided. You know, there were some like NHS were, so I thought, well, if I do lose weight, it can’t do any harm and plus I do need to lose weight, you know. So I went I did lose and but the alcohol was another, if there was a trigger point there and it stopped me, bearing in mind I was I was in a different condition of AF then and so I was partially in, well, majority of the time, I was in sinus rhythm. So if alcohol or caffeine was one of the trigger points, then if I could get them out of my diet then it may well get rid of the forty per cent, you know, the times I was in AF. But that didn’t quite didn’t quite hold, but there was there was quite a few times I where I when I was, especially when I was, after sort of three months three or four months of being teetotal and caffeine free, I did feel that, “Oh, you know.” And there’d been less episodes and so I did feel that it was positive and now it’s in permanent I’ve sort of been, I’ve been disappointed in that respect.
As well as trying to identify a primary cause for their AF, people also talked about their efforts to work out triggers which set off episodes of AF. In addition to factors such as stress, alcohol and caffeine (in coffee, tea, and cola drinks), people we interviewed mentioned changes in posture, for example lying down, having a coughing fit, anxiety, and eating a lot of heavy food or food with additives. 
(For more see ‘Reducing stroke risk through other medication and lifestyle changes after diagnosis of atrial fibrillation’)
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