Lifestyle modifications for treatment of atrial fibrillation

Melissa E. Middeldorp, Jonathan Ariyaratnam, Dennis Lau, Prashanthan Sanders

Research output: Contribution to journalReview article

Abstract

The management of atrial fibrillation (AF) has focused on anticoagulation, rhythm control and ventricular rate control. Recently, a fourth pillar of AF management has been incorporated recognising the importance of risk factor management (RFM). There are several risk factors that contribute to the development and progression of AF, these include traditional risk factors such as age, hypertension, heart failure, diabetes and valvular heart disease. However, increasingly it is recognised that obesity, sleep apnoea, hyperlipidaemia, smoking, alcohol, physical inactivity, genetics, aortic stiffness are associated with the development of AF. Importantly, several of these risk factors are modifiable. We have seen the evolution of RFM programmes which have demonstrated promising results. Indeed, the evidence is now so compelling that major clinical guidelines strongly advocate that aggressive treatment of these risk factors as a key component of AF management. Patients with AF who comprehensively managed their risk factors demonstrate greater reduction in symptoms, AF burden, more successful ablations and improved outcomes with greater AF freedom. In this article, we will review the evidence for the association between cardiac risk factors and AF and assess the burgeoning evidence for improved AF outcomes associated with aggressive cardiac RFM.

LanguageEnglish
JournalHeart
DOIs
Publication statusPublished - 19 Nov 2019

Keywords

  • atrial fibrillation
  • hypertension
  • metabolic syndrome
  • obesity
  • smoking cessation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Middeldorp, Melissa E. ; Ariyaratnam, Jonathan ; Lau, Dennis ; Sanders, Prashanthan. / Lifestyle modifications for treatment of atrial fibrillation. In: Heart. 2019.
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Lifestyle modifications for treatment of atrial fibrillation. / Middeldorp, Melissa E.; Ariyaratnam, Jonathan; Lau, Dennis; Sanders, Prashanthan.

In: Heart, 19.11.2019.

Research output: Contribution to journalReview article

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AU - Lau, Dennis

AU - Sanders, Prashanthan

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N2 - The management of atrial fibrillation (AF) has focused on anticoagulation, rhythm control and ventricular rate control. Recently, a fourth pillar of AF management has been incorporated recognising the importance of risk factor management (RFM). There are several risk factors that contribute to the development and progression of AF, these include traditional risk factors such as age, hypertension, heart failure, diabetes and valvular heart disease. However, increasingly it is recognised that obesity, sleep apnoea, hyperlipidaemia, smoking, alcohol, physical inactivity, genetics, aortic stiffness are associated with the development of AF. Importantly, several of these risk factors are modifiable. We have seen the evolution of RFM programmes which have demonstrated promising results. Indeed, the evidence is now so compelling that major clinical guidelines strongly advocate that aggressive treatment of these risk factors as a key component of AF management. Patients with AF who comprehensively managed their risk factors demonstrate greater reduction in symptoms, AF burden, more successful ablations and improved outcomes with greater AF freedom. In this article, we will review the evidence for the association between cardiac risk factors and AF and assess the burgeoning evidence for improved AF outcomes associated with aggressive cardiac RFM.

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