• Dr. Nathan Keiser

Working Long Hours? Risk For Atrial Fibrillation May be 40% Higher New Study Shows.

I was doing my usual reading some research to end my day when I read this article, wrote this first paragraph and STOPPED WORKING.

A recent article published in the European Heart Journal (EHJ), that suggests "Individuals who work long hours were more likely to develop Atrial Fibrillation (AFib) than those working standard hours."—Wow, this is big news.

The study looked at data from 85,494 working men and women with zero cases of Atrial Fibrillation when they began the study and then reevaluated after a 10 yr. period. When comparing the group that worked more than 55 hours per week they found 40% were more likely to have atrial fibrillation than those who worked between 35-40 hours per week. (Yeah, that was my thought too.)

If you are not familiar with atrial fibrillation, it is a condition where there is a failure of the brain to effectively regulate the autonomic nervous system that controls the pacing of the heart. In a normal heart, the top chambers and bottom chambers beat in synchrony, squeezing the chambers and pushing blood to all vital areas. The system functions wonderfully.

When the pacing is affected in Atrial Fibrillation, the heart experiences periods of chaos. The top chambers of the heart (the atria) are stimulated so relentlessly they no longer contract and begin to quiver or tremble. This is what is referred to as fibrillation or flutter. In this state, the atria can no longer contract effectively and cardiac output takes a major hit. If the heart isn't pumping blood, your body, more importantly, your brain is not being properly nourished. At this stage, you feel the racing in the chest along with a sense of anxiety that can lead to or panic. This may create a feeling of dizziness or lightheadedness. This can lead to losing consciousness or severe brain fog. The risk of stroke skyrockets, and the risk of vascular dementia and neurodegenerative syndromes follows suit.

“When the pulse is irregular and tremulous and the beats occur at intervals, then the impulse of life fades; when the pulse is slender (smaller than feeble, but still perceptible, thin like a silk thread), then the impulse of life is small.”

-Huang Ti Nei Ching Su Wen-The legendary emperor physician is believed to have ruled China between 1696 and 2598 BC. The poor prognosis associated with chaotic irregularity of the pulse was clearly acknowledged by most of the ancient physicians

AFib is the most common heart rhythm abnormality that we experience in western culture. The frequency increases with age affecting as much as 5% of the total population in people age 75 and older. There is also a noticeable trending toward an increase in AFib that begins in younger people in their 20’s and 30’s. For some, the experience can take place once in a blue moon after a vagally mediated event. Coughing, vomiting, standing up or even over-indulging in food or alcohol, which has whimsically been described as "holiday heart."

For others, the picture is a bit different. AFib can be more persistent lasting days, weeks, months or even become permanent. A common saying in the afib community is "afib begets afib." Based on the current understand, we can essentially say that if something is not done to address the causality, the syndrome gathers speed which can have a larger impact on daily life and increases the risk of injury such as stroke.

The "Long Hours Promoting AFib" publication helps shine light on theories that neurologists, cardiologist, and electro physiologists have held for decades. The blogger and more recently published author of the book "The Haywire Heart" Dr. John Mandrola has an excellent post on the topic in which he describes the most common known mechanisms of atrial fibrillation as being self-inflicted.

The terminology seems harsh, but he is right. The leading causes of illness and death in our culture are closely related to preventable illnesses, secondary to lifestyle choices. Usually when someone makes reference to lifestyle choices, they are referring to those decisions revolving around diet and a sedentary lifestyle--"Fast food, computer work and reality TV/video games."

People with atrial fibrillation eventually fall into this category as well, but there is a whole other category that the EHJ article and Dr. Mandrola point to that, is in my eyes, perhaps more striking. What about the people on the other side of the lifestyle spectrum? There is also the group of over-achievers, the go-getters. People that push hard on multiple levels; physically, mentally and emotionally, are typically where onset may be more dangerous. They feel like everything is great, don’t experience stress, and are often still achieving at a high level until all of a sudden, the aren't.

Dr. Mandrola makes reference to cyclists logging hundreds of miles per week while also attending to work and families. Some do this for decades without taking a pause or hiatus.

For others, the poison of their picking is work. Long hours, lots of travel, little sleep, being tethered to email and text messages, constantly putting out fires all in the name of “progress.”

This pattern of over-work, over-stress or overwhelm, lies in close relationship with what we see with autonomic nervous system (ANS) maladies. The ANS is the brain's control system that monitors and controls all of the automatic functions of the body, including heart rate and rhythm. In the current state of research, there seems to be a couple different lines of thinking. Researchers are looking into structural changes in the heart as the primary culprit for AFib. In this scenario, portions of the cardiac cells undergo structural changes and develop instability in the cell membrane. This may change the conductivity of the cells causing rogue depolarization of the heart tissue causing it to contract erratically and out of rhythm. There is another body of evidence which looks at the neural integration that exists along the path from the brain to the heart. Some evidence suggests that the ANS loses its ability to stabilize the balance within the system, thus creating instability in the cardiac tissue. Currently, both hypotheses are plausible and have merit. My suspicion is that there is probably truth in both stories. The way it looks, the sequence of events that seem to accompany AFib, mirror too closely to what we see in other dysautonomic syndromes. This leads me to believe there is a strong relationship.

Afib is a condition that has received a lot of attention which has led to a steady stream of research. When I read an article like this, I often find myself looking into the history books looking for correlations and asking questions. The most salient question for me; "Has AFib always been this prevalent?"

This paper has taken massive steps in large-scale collaboration to begin putting data behind the suspicions of our colleagues in healthcare.

As the authors are quick to point out, there are certainly limitations to the project. The data covering work hours was initially collected 10 years prior and compared to current health reporting. Unfortunately, we don't know if they continued to work at that pace or if it changed. We can predict that often work habits remain similar and they would likely continue. We could also pontificate and wonder those working fewer hours may have climbed the corporate ladder, taking on a greater workload and with it, a greater incidence of AFib. This could mean the number of AFib’ers in the "long hours" group may even be higher.

Either way you slice it, the findings are compelling and should help guide further research into the causes of atrial fibrillation.

What can we do with this information?

The lesson we can take from this paper is that perhaps we aren't made to go at full speed all the time. Even the Cheetah spends most of its day in rest and stillness. If you are concerned that you may find yourself in this boat, or have felt the occasional flutter or fish flop in your chest, go visit your cardiologist or electrophysiologist.

Evaluate your current habits-

-Are you over-worked? Have you taken a real unplugged vacation? Working overtime most weeks?

-Are you over-exercised? Have you participated in high output exercise, particularly endurance training like cycling, running, swimming or cross-training for years without taking more than a couple weeks off?

-Is stress taking playing a larger role in your daily life? Are you constantly shifting your attention from task to task without giving yourself time to relax your mind? Has the quantity or quality of your sleep been affected?

-Are you at peace? Do you worry about the future of you, your family or loved ones? Does spiritual uncertainty and unrest hang over your head?

-Are you eating well? Too many meals on the go or overindulgences that come too frequently?

This is a place to start... for anybody... and in reality, most people that fit this pattern, don't feel over-worked, or over-whelmed or over-trained, because it comes upon you slowly. Learning how to master and manage a lifestyle including a pause to rest (and I mean really rest, not doing ANYTHING and being ok with it) monitoring your training and keeping the goals in perspective for your lifestyle just might be the key to your longevity.

And, if all else fails, DON'T WORK SO MUCH! ;).

Dr. Keiser is a chiropractic neurologist practicing in Wixom MI. He is also a husband to a chiropractic neurologist, a father, a fitness and athletic enthusiast, and an assistant professor of clinical neurology at the Carrick Institute of Graduate Studies.

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