Derek Burnett
Derek Burnett is a Contributing Writer at Bottom Line Personal, where he writes frequently on health and wellness. He is also a contributing editor with Reader’s Digest magazine.
When first told that they have atrial fibrillation, many people begin wondering what they might have done to bring on the condition. Among other factors such as diet, lack of exercise, and diabetes, might stress have played a role?
After all, atrial fibrillation, or “A-fib”, is a rapid, disorganized heart rhythm, and most of us have an intuitive sense that there is a connection between anxiety and our heartbeat. If you’ve ever had to give a speech in front of a large crowd, you’ve no doubt felt your heart begin racing. Even lying awake at night stressing about bills, your children’s future, or a crisis at work, you might have felt your heart pounding in your chest.
The heart’s rhythm is controlled by precise electrical signals. When those electrical pulses become disturbed, the result is a rapid, irregular heartbeat that causes the upper chambers of the heart, called the atria, to quiver (“fibrillate”) erratically and out of sync with the heart’s lower chambers, known as the ventricles. This rhythm is inefficient, compromising the heart’s ability to pump blood out to the body. It often (but not always) brings symptoms of fatigue, dizziness, and tightness in the chest. More crucially, a heart in atrial fibrillation fails to drain its chambers sufficiently, leaving behind blood that can clot in the heart, travel to the brain, and cause a stroke.
Given the nature of atrial fibrillation as just described, along with our intuitive understanding of a connection between stress and heartbeat, it makes sense to ask whether stress and anxiety might be able to upset the heart’s electrical signaling, causing the organ’s rhythm to go into fibrillation. Here’s what we know about the role of stress in afib.
When we talk about stress and other factors associated with atrial fibrillation, it’s important to make a distinction between causes and triggers. The word “cause” is usually taken to mean something without which an event or state of being would not exist. In other words, saying, “I have atrial fibrillation caused by my anxiety” implies that if only you had not been so stressed your heart would never have gone into A-fib. That would be very difficult to say with any kind of certainty. On the other hand, there is evidence to suggest that stress and anxiety can “trigger” atrial fibrillation. The “trigger” paradigm implies that other factors are already in place and that your anxiety could represent a tipping-point that ushers in a state of atrial fibrillation. Anxiety might be one of several possible triggers…others can include large meals, becoming dehydrated, drinking alcohol, and getting an inadequate amount of sleep.
The “trigger” concept also brings out another important point. There are three types of atrial fibrillation, categorized by how frequently or persistently they occur:
Understanding the various types of A-fib may help you better conceptualize the relationship between atrial fibrillation and triggers. If you have paroxysmal or persistent A-fib, your heart is not in a constant state of fibrillation, but could possibly begin fibrillating at any moment. Lifestyle and other risk factors are considered the triggers.
Anxiety is both a risk factor for and a trigger of A-fib. A 2023 review conducted by researchers at the University of Liverpool in the United Kingdom and published in the journal Frontiers in Cardiovascular Medicine took a deep dive into the connections between mental stress and the electrophysiology of the heart. While calling for further study, it found good evidence to support the idea that long-term, chronic stress takes a toll on the cardiovascular system that might include the kinds of changes to electrical signaling in the atria that we associate with A-fib. To put that more simply, chronic stress could be a risk factor for developing atrial fibrillation because it may disrupt the heart’s electrical system.
However, it’s important to note that the people included in most of these studies had some form of heart disease already. There is currently little evidence suggesting that someone with a healthy heart who experiences chronic stress will develop atrial fibrillation. It must also be noted that some studies included in the analysis found no association between anxiety and the development of A-fib.
That 2023 review, however, was not only concerned with “incident” atrial fibrillation, meaning its first onset. It also sought to understand anxiety as a trigger of existing A-fib. The analysis included research papers with the following findings:
Whether or not anxiety is an independent risk factor for developing atrial fibrillation, experiencing uncontrolled, long-term stress almost certainly contributes to A-fib risk because of its relationship with other risk factors. What do people do when they’re stressed out? They binge eat, smoke cigarettes, drink too much, get poor sleep, and skip the gym…all of which are associated with conditions known to be risk factors for A-fib (obesity, lung disease, diabetes, and so on).
Unfortunately, stress tends to be the runt of the litter when it comes to risk factors for A-fib. People often get serious when warned about the health hazards of smoking or a poor diet, yet when they hear about the dangers of stress, they nod their heads and then do nothing about it, it’s very likely they are unable to change the source of that stress (i.e., a job, family issues, etc.).
However, experts say there are things you can do about it, and they wholeheartedly suggest that you should consider the following:
If you’re a particularly driven and pragmatic person, such things may seem corny or superfluous. But they’re worth doing…especially when weighing your stressful lifestyle against your health and longevity, which should take precedence over other considerations.
