Atrial fibrillation (AFib) is an irregular heartbeat that increases the risk of stroke and other serious complications. More people than ever have AFib. While family history and getting older can play a part, you can control something that can make you more likely to have AFib: your weight. Being overweight or obese greatly increases risk for AFib and can worsen outcomes for those who have the condition.
Understanding Atrial Fibrillation (AFib)
About 10.5 million Americans have AFib. If you’re one of them, your heart isn’t getting the right electric signals to tell it when to contract or relax. As a result, the upper chambers can’t beat in a normal pattern and your heart can’t pump blood as well as it should.
AFib can cause weakness, shortness of breath, and heart palpitations, when you feel like your heart has skipped a beat. It might feel fluttery, or like it’s racing or pounding. AFib also raises your odds of more severe health problems, like stroke, kidney disease, and heart failure.
The Link Between Obesity and AFib
If you’re obese -- meaning you have a body mass index (BMI) of 30 or higher -- you’re twice as likely to have AFib. The higher your BMI, the more likely you are to have AFib. Extra fat, especially around your waist, has a direct effect on your heart. Over time, it can build up in your arteries and damage your heart’s left ventricle (its main pumping chamber.) This prevents it from filling up as much as it needs to between beats.
Excess weight also causes electrical and chemical changes to your heart. It can raise the amount of inflammation in your body. Plus, when you’re obese, you’re more likely to have other health issues, such as hypertension, coronary artery disease (CAD), sleep apnea, and diabetes. Each of these is linked to increased AFib risk, too.
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Weight Loss: A Potential Reversal Strategy
Losing extra weight can make a difference. Australian research shows for the first time that obese people who are suffering from atrial fibrillation can reduce or reverse the effects of the condition by losing weight. In one study, obese people who shed at least 10% of their body weight were 6 times less likely to have this abnormal heartbeat again.
The study is the first to track the long-term effects of weight loss and the degree of weight fluctuation on atrial fibrillation burden. "Previous studies have shown that weight management can reduce atrial fibrillation symptoms in the short term and improve outcomes of ablation [a surgical treatment for atrial fibrillation]," said Rajeev Pathak, M.D., a cardiologist and electrophysiology fellow at the University of Adelaide, Adelaide, Australia and the study’s lead author.
"We found that sustained weight loss is achievable in obese patients and that it can significantly reduce the burden of atrial fibrillation," Pathak said. Researchers enrolled 355 participants in a dedicated weight loss clinic and tracked their health annually for an average of four years. All participants were obese and had atrial fibrillation at the start of the study.
To encourage weight loss, the clinic used a motivational, goal-directed approach that included three in-person visits per month, detailed dietary guidance, low-intensity exercise, support counseling and maintenance of a daily diet and physical activity diary. Participants returned to the clinic annually for a health exam and atrial fibrillation monitoring. To assess the frequency, duration and severity of symptoms, patients completed questionnaires and wore a Holter monitor, a machine that tracks the heart’s rhythms, for seven days.
After an average of four years, 45 percent of patients who lost 10 percent or more of their body weight and 22 percent of patients who lost 3 to 9 percent of their weight achieved freedom from atrial fibrillation symptoms without the use of any atrial fibrillation surgery or medication. Only 13 percent of patients who lost less than 3 percent of their body weight were free of symptoms without these treatments. Sustained weight management and a linear weight loss trajectory were also associated with greater freedom from atrial fibrillation. A 10% loss in weight along with management of associated risk factors can reverse the progression of the disease.
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Progression of the disease is shown to have a direct link with the degree of weight loss. People who lost weight experienced fewer symptoms, required less treatment and had better outcomes.
The LEGACY Study
Designed to assess the impact of weight loss on AFib, a study called LEGACY offered weight loss programming to overweight or obese patients treated for atrial fibrillation at a large heart center in Adelaide, Australia. A total of 355 patients participated in the study, each of whom received counseling and weight loss support in addition to standard treatment for AFib, such as blood thinners and medication that helps control heart rate.
After tracking the health and weight of participants for two years, researchers found that the more weight patients lost, the better their outcomes were. For example, patients that lost more than 10% of their body weight over the study period were six times more likely to live AFib-free compared to those patients losing less than 10% of their weight or no weight at all. Patients losing the greatest amount of weight also were less likely to experience common AFib symptoms, such as fatigue and shortness of breath. However, patients had to lose weight and keep it off for the greatest benefits. Based on their findings, authors believe that weight loss and weight maintenance are important strategies for treating AFib.
Weight Loss and Cardiac Ablation
Sometimes, doctors can treat AFib with drugs that reset your heart’s rhythm. If you can’t take medicine or it doesn’t work, surgery is an option. Cardiac ablation is a common AFib treatment. During this surgery, the doctor threads a long tube called a catheter through your blood vessels and up to your heart. Then they use radio waves, heat, or extreme cold to destroy the damaged tissue that’s causing your AFib.
Although ablation takes away the need for long-term medicine or a surgical implant to correct your heartbeat, it’s less likely to be a good option if you’re obese. The odds that your AFib will come back after this treatment are higher than for someone with a normal BMI. Even small increases in BMI can raise the odds. And if your BMI’s over 40, you’re also more likely to have side effects from a cardiac ablation.
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Weight management also can reduce the risk of recurrent AFib after having a cardiac ablation procedure to correct the abnormal heart rhythm. Results from a new clinical trial found overweight and obese patients with persistent and paroxysmal atrial fibrillation (AF) who lose weight prior to a catheter ablation procedure have improved clinical outcomes. The study identifies weight loss before undergoing an ablation procedure as a risk-factor reduction tool for AF patients.
How to Achieve Weight Loss for AFib Management
So what’s the best thing to do if you’re obese and likely to have AFib? Experts believe the answer is weight loss.
- Eat less, move more. Lower the amount of calories you eat and drink. Raise your exercise. Your doctor can tell you how to do this safely.
- Focus on healthy foods. Fresh, whole foods like fruits, vegetables, and whole grains give your body the nutrients it needs without extra calories.
- Start small. Choose goals that are clear and easy to reach -- you’re more likely to stick to them. Here’s a good one: Say you’ll cook a healthy dinner and skip fast food two nights this week.
- Track your progress. Log your food, count your steps, and check in often with a friend or counselor.
- Be patient. Weight loss takes months and sometimes years, not days. Aim for a lifestyle change you can sustain for the long run, rather than a crash diet that leaves you feeling deprived.
- Talk to your doctor. If you’re obese, you may need more than diet and exercise to shed your extra pounds. Bariatric surgery (which makes your stomach smaller or makes changes to your small intestine) can help your heart, too. Newer medications, including GLP-1 (glucagon-like peptide-1), are used to treat type 2 diabetes and can also lead to weight loss.
Getting to a healthy weight will also help manage other health problems like blood pressure, sleep apnea, diabetes, and hyperlipidemia (high cholesterol). Once those are under control, your heart should work better, too.
The Role of Sustained Weight Management
Sustained weight management and a linear weight loss trajectory were also associated with greater freedom from atrial fibrillation. Patients who lost and then regained weight, causing a fluctuation of more than 5 percent between annual visits, were twice as likely to have recurrent rhythm problems than those who did not experience such fluctuations. Losing weight and keeping it off reduces atrial fibrillation burden and improves maintenance of sinus rhythm.
Additional Benefits of Weight Loss
Weight loss was also associated with significant beneficial structural changes in the heart and significantly improved other markers of heart health including blood pressure, cholesterol and blood sugar levels. The greater the weight loss, the better the effect on structural remodeling, as indicated by reduction in the size of the left atrium, and on inflammation, as measured by high-sensitivity C-Reactive Protein (hs-CRP).
The UT Southwestern Atrial Fibrillation Wellness Program
Managing the complex conditions of obesity and AFib requires an evidence-based, personalized treatment strategy. Simply telling patients to “eat less and move more” isn’t effective.
That’s why specialists from UT Southwestern’s Heart Rhythm Management team and Weight Wellness Program have joined forces to start a first-of-its-kind Atrial Fibrillation Wellness Program that addresses the dual risk factors for patients with AFib and obesity. Led by board-certified cardiologists and obesity medicine specialists, our comprehensive care team will offer patients treatments that will include the latest and most effective anti-obesity medications, nutritional counseling, mental health care, exercise, and much more - all with the purpose of addressing both diseases to improve your cardiovascular health and quality of life.