The link between some rare, hereditary, heart diseases and stress is fairly well studied and understood. However, the relationship between stress and atrial fibrillation is not quite as unambiguous, and a scientific consensus is yet to fully form.
As with our study on alcohol, we will divide this post into:
1) Stress as a risk factor for developing atrial fibrillation.
2) Stress as a trigger if one already has a tendency towards recurrent atrial fibrillation.
Stress as a risk factor for atrial fibrillation
There are two large population surveys from the United States and Sweden, respectfully, that provide some insight into the links between Atrial Fibrillation and stress:
- The Framingham Studies – A systematic study of the health and illness of ordinary Americans from Framingham, MA.
- The Wolf Study – A study from Sweden that follows similar characteristics
These studies both show that prolonged exposure to stress, defined as a period of 10 years or more, is associated with a higher risk of developing atrial fibrillation. However, a large study of women, the Women’s Health Study, was unable to find such a connection among women.
This shows that there is some evidence that there is a connection, at least among men, between many years of stress, and the development of atrial fibrillation.
Stress as a trigger for atrial fibrillation
If you already have a tendency towards atrial fibrillation, can stress be a factor that triggers episodes of arrhythmia?
A smaller study from 2016 has looked at the connection between stress and numbers of seizures in persons already diagnosed with atrial fibrillation. The study has regularly recorded the heart rate and symptoms of stress and happiness. These measurements were taken partly when the heart rhythm was measured, and partly at the end of each day.
This enabled the study to understand the link between the expected number of atrial fibrillation episodes and its relation to the “stress factors”. The study found that attacks were more common when there was a large number of stress factors 30 minutes prior to an episode. It also noted that attacks were more common when many stress factors were noted the evening before an attack.
Negative emotions, specifically depression, anxiety, anger and “stress”, led to a 2-5 times increase in the risk of a case of atrial fibrillation. Conversely, “joy” was associated with an 85% reduction in the risk of AF. Anger and stress at the end of the day almost doubled the risk of an AF attack the next day.
To my knowledge, this study is the first that has systematically looked at “stress factors” as triggers for atrial fibrillation. However, the study is so modest in size that the results can not be taken 100% as an expression of a “true” connection between stress and atrial fibrillation.
Despite this, I think that many readers with AF will recognize and agree with these observations. It is my own experience that patients often associate “bad” periods where you experience a lot of atrial fibrillation with simultaneous stress – work-related or something else. But also that “good” periods with no or only modest atrial fibrillation are associated with good times.
Why is there a connection between stress and atrial fibrillation?
It is difficult to give a definitive answer, but we can draw some tentative conclusions. First of all, it is known that negative emotions such as anger, sadness or anxiety affect the part of the nervous system that we do not normally have control over, the autonomic nervous system.
Simply described, the autonomic nervous system has two components: the sympathetic and the parasympathetic nervous system. Affecting the autonomic nervous system can cause the heart muscle cells in the atria to become more irritable and more easily both trigger and maintain the flicker.
At the same time, negative emotions also affect the secretion of various hormones in the body, including cortisol and adrenaline / noradrenaline from the adrenal glands. These hormones can also help make the heart muscle cells more prone to atrial fibrillation.
Can This Knowledge Be Used To Reduce The Incidence Of Atrial Fibrillation?
Both the connection between negative emotions and increased incidence of atrial fibrillation, but certainly also the connection between positive emotions and less incidence of atrial fibrillation are, in my opinion, very interesting observations.
There are not yet results from larger studies, where one has systematically tried to influence the “stress burden” with activities such as yoga, meditation or acupuncture, and the effect on atrial fibrillation. However, it is a hugely interesting area, and I have seen a 52 patient study that has demonstrated that yoga twice a week reduced the symptoms of atrial fibrillation and improved quality of life compared to the period before the yoga training.
This may indicate that maintaining a positive state of mind could be an invaluable tool to improve your quality of life.