Tracking Potential Triggers May Reduce Number of Episodes for Patients With Atrial Fibrillation

Common triggers for atrial fibrillation include alcohol, caffeine, and less sleep.

Patients with atrial fibrillation (AFib) who underwent individualized testing to discover triggers for their irregular heartbeats reported less frequent irregular episodes, according to research presented at the American Heart Association’s Scientific Sessions 2021. As patients report that certain behaviors appear to increase the likelihood of an AFib episode, the I-STOP-AF trial was designed to determine whether monitoring potential triggers could reduce AFib episodes.

“There has been little research done on whether perceived triggers of AFib actually lead to AFib episodes,” said Gregory Marcus, MD, MAS, professor of medicine at the University of California, San Francisco School of Medicine and associate chief of cardiology for research at UCSF Health, in a press release. “Our research team aimed to determine whether perceived triggers equate to actual triggers—and whether tracking triggers for AFib could lead to fewer episodes.”

The investigators enrolled 446 participants, 320 of whom completed the study. These patients were randomized to either monitor their AFib episodes without tracking their presumed triggers or to test whether specific triggers affected or caused atrial fibrillation episodes.

Patients tracking AFib triggers could select from a menu or write in a personalized trigger at the start of the study. Common triggers included alcohol, caffeine, and less sleep. Participants were then instructed to either expose themselves or to avoid a specific trigger during a given week.

According to the investigators, patients who completed the individualized trigger study reported less frequent episodes of atrial fibrillation during the 4 weeks following their testing compared to those who only tracked AFib episodes. Drinking alcohol was associated with a greater number of atrial fibrillation episodes, whereas caffeine consumption was not linked to any increased risk.

“As this was the first study to tackle this idea, there are many lessons we have learned that future studies could build upon,” Marcus said in the release. “We also had a unique opportunity to work closely with patients who have atrial fibrillation including several atrial fibrillation patients who are now co-authors of the study. It’s important for us, as health care professionals, to focus on patient-centered outcomes.”

These findings demonstrate the need for a greater number of real-time assessments, the investigators said. They also believe assessments of possible AFib triggers can empower patients by alerting them to behaviors they can change in their daily lives.

The investigators noted several potential limitations, including that all study participants did not complete all assessments and that the study relied on self-reported responses to determine compliance with AFib trigger testing assignments.


Monitoring for individual triggers may reduce episodes of atrial fibrillation [news release]. EurekAlert; November 15, 2021. Accessed November 16, 2021.

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