Atrial Fibrillation Archives - York Cardiology

The connection between atrial fibrillation and the stomach

By | Atrial Fibrillation, cardiology, heart disease | No Comments

Today I again wanted to write about atrial fibrillation (AF) and in particular explore the connection between AF and how gastric issues could be associated with an increased likelihood of AF

We know that gastric issues are extremely common in people these days and in particular many people suffer from hiatal hernia which means that part of the stomach can protrude through into the chest cavity and as this can actually mechanically compress on the left atrium and therefore increase likelihood of atrial heart rhythm disturbances.

There is an interesting study that I came across in the Journal of Afib from 2013 by Roy et al and what they wanted to find out whether people with a hiatus hernia have a much higher prevalence of atrial fibrillation. They looked at all patients who had a diagnosis of hiatus hernia and had been seen at the Mayo clinic in Rochester from Jan 1st 1976 to 31st dec 2006 and they also looked to see if they also had a diagnosis of AF. They then compared to this ti the reported prevalence of AF in patients of similar age and gender in the general population.

What they found was very intesting indeed. In younger men aged less than 55 years, AF was present in 3.5% of the population with hiatal hernia and only in 02% of the general population..I.e a 17.5 fold higher!


Men 55-59 years 7.8 fold increase
60-64 years 5.9 fold increase
65-69 years 4 fold increase
70-74 years 2.4 fold increase
75 – 85 years 1.2 fold increase

Similarly in women under the age of 55, there was a 19 fold higher incidence of AF compared to the general population.

Women 55-59 11.7 fold increase
60-64 years 5.9 fold increase
65-69 4 fold increase
70-74 2.4 fold increase
75-79 2 fold increase
80-84 1.6 fold increase

So it appears that in some way hiatus hernia is associated with increased prevalence of atrial fibrillation. However association does not automatically imply causation; and therefore I was keen to see if there was any evidence that treating the hiatus hernia can improve AF.

I found a few interesting case reports in the literature suggesting possible causation.
Schilling et al reported a case of patient who had atrial flutter and a large paraesophageal hernia and once the patient had an operation to repair the hernia he had no more atrial flutter.

There was another case of paroxysmal flutter that didn’t respond to an even ablation but once he was started on PPIs sinus rhythm was maintained at 1 year of follow-up

I also found another case where a patient with a large paraesophageal hiatus hernia regularly developed Afib after eating found that his symptoms disappeared after he had sugery

The mechanisms by which the hiatus hernia could cause AF are 3;
1. Mechanical compression
2. Inflammation
3. Increased vagal tone from the reflux could cause AF

So I hope this was useful for you. Here is a link to my video on this subject




Common triggers for atrial fibrillation

By | Atrial Fibrillation, cardiology | No Comments

Today’s blog is on Atrial fibrillation and this is particularly relevant to those of you who have paroxysmal Afib which means that the AF can come and goes of its own accord.

Most people with paroxysmal AFib seem to tolerate Afib very badly..they feel lethargic breathless, tires and get palpitations and they don’t know how long it is going to go on for.

What we do know is that there are often triggers which can increase the chances of an Afib attack happening and recognizing the triggers and avoiding them can make a big difference to the frequency of attacks.

So i found an interesting study where 100 people were asked what they felt were their major triggers: This is by Hansson et al in the BMC cardiovasc disorders in 2004

100 people were asked about their triggers. There were 72 men and 28 women
Paients ranged from as young as 22 years to 79 years
76 of the 100 were taking tablets (sotalol) and 24 were not taking any medications
72 patients felt that their symptoms starteed at around about the same time of the day and the majority occurred between 6-9 pm but also from midnight to 9 but the least number complained of symptoms starting from 9-3pm.
35% woke up with AF
31% occurred during rest and 22% occurred after physical exertion
for most patients 64% attacks typicaly lasted less tan 1 day, 17% said they lasted between 1-7 days and none had it for more than a week
The commonest triggers were mental stress (54%), physical effort (42%), tiredness (41%), alcohol 34%, certain foods (25%)
If you can identify and avoid your triggers, you will hopefully get less AF. Please do consider liking, commenting and sharing. Also please visit my Facebook page ([email protected]).


Here is a video on this subject.

Can stress cause atrial fibrillation?

By | Atrial Fibrillation | No Comments

My name is Sanjay Gupta and I am a cardiologist in York. One of the commonest questions i get asked by patients suffering from atrial fibrillation is:

Can stress cause atrial fibrillation?

Today’s blog is therefore on the subject of emotional stress and how it can trigger Afib.

This is a subject that is very close to my heart because whilst everyone believes that the reason there is so much illness about is because of an aging population, i have always maintained that it is more to do with lifestyle. And whenever lifestyle is mentioned people assume that lifestyle relates to exercise and diet. However to my mind perhaps the most important yet most neglected component of lifestyle is stress.

We live in a hugely stressful world and stress is everywhere and to my mind stress is perhaps the single biggest cause of morbidity and mortality and it is unfortunate that our politicians are happy to give millions of pounds to pharamceutical companies to bring wierd and wonderful drugs to treat medical illnesses, they don’t invest at all in strategies to help reduce stress and thereby prevent disease from happening in the first place. And the simple reason for this is that preventing disease is not as profitable as treating disease!

We know stress is hugely inflammatory to the body and most chronic western world illnesses arise from long term chronic inflammation.

This week, I found a very interesting study in the journal of American college of cardiology and this was published in Oct 2014. The lead author is Rachel Lambert and the study was called ‘triggering of symptomatic atrial fibrillation by negative emotion’

95 patients paroxysmal AF were studied.All were in sinus rhythm at the time of enrollment.
They were asked to keep an electronic diary summarising their emotions for the day at the end of each day for a whole year. They were asked to fill in if they had been happy, sad, angry, stressed, impatient, anxious or hungry.
They were given a loop recorder so that they could record their symptoms when they felt that they had gone into Afib and then they were also asked to fill in exactly what their emotions were just before theu developed their symptoms.
Once a month, they were also given a 24 hour tape and every 30 minutes they were asked to fill in how they were feeling.

So the researchers then used the result to compare 2 things:
Did emotional status influence whether you had an Afib attack on the same day?
Did emotional status on the day before impact on whether you had an Afib attack the next day?

The results were amazingly interesting!

Stress, Anxiety and sadness and anger all increased the likelihood of Afib
Happiness was incredibly protective
In fact the likelihood of AF events was 85% lower after reports of happiness!

They also found that if the patient had reported being stressed or angry the day before then this almost doubled the likelihood of AF on the following day. The more the stress the more likely an episode of AF!

So in summary this study very elegantly showed that negative emotion can trigger Afib.

And this is why i think that being mindful of the huge negative impact that stress can have on our health is so important and giving priority to those aspects of your life that genuinely give you happiness and destress you is a very worthwhile investment.

Here are some more videos on the subject of Afib

Also if you would like to speak with me please come and join me on my facebook page (yorkcardiology1), my website is and my twitter id is yorkcardiology.