Smoking and AFib: Does It Trigger Atrial Fibrillation?

Smoking and AFib are linked: people who smoke are more likely to develop atrial fibrillation, an irregular heart rhythm that raises the risk of stroke. The extra risk is real but moderate, and it is smaller in people who have quit. If you or someone you love has been told to stop smoking because of AF, this guide sets out what the research shows, what is still unknown, what to ask about nicotine replacement, and what changes after quitting.

Smoking and AFib: the short answer

The NHS defines it this way: “Atrial fibrillation (sometimes called afib or AF) is a type of heart rhythm problem where your heartbeat is not steady.” Its page on atrial fibrillation lists smoking among the things that make you more likely to get it, alongside being 55 or older, being a man, obesity or overweight, certain medicines and endurance sports. Under what you can do yourself, it says “do not smoke.”

Smoking is therefore a recognized risk factor, but it is not the only one and it does not mean you will develop AF. Many people with AF have never smoked, and many smokers never develop it. The question is how big the extra risk is, which the next sections answer with published numbers.

How smoking affects heart rhythm

The NHS explains that AF “is caused by a problem with the electrical system that makes your heart beat.” It does not spell out how smoking disturbs that system, and health bodies do not set out a single agreed mechanism, so this guide does not speculate. What the large studies show is an association that grows with the amount smoked, covered below.

It helps to separate rhythm from rate. Smoking and nicotine also raise heart rate and strain the heart, which we cover in our hour-by-hour guide to heart rate after quitting smoking hour by hour, but a faster heartbeat is not the same thing as an irregular one. The NHS describes AF as a heartbeat that is not steady, sometimes faster than 100 beats per minute, and sometimes with no symptoms at all.

Risk figures: current vs former smokers

The key evidence is a 2018 systematic review and meta-analysis of prospective studies in the European Journal of Preventive Cardiology, which pooled 29 studies. Compared with never smokers:

The authors concluded that “smoking is associated with an increased risk of atrial fibrillation in a dose-dependent matter, but the association is weaker among former smokers compared to current smokers.” A relative risk of 1.32 means roughly a third more cases than among never smokers, and the difference for former smokers (1.09) is small, with a confidence interval that touches 1.00. Results across the studies varied considerably, so treat these as averages, not predictions for you.

This same pattern shows up in clots, where smoking’s effect is real but modest; see our article does smoking cause blood clots.

This British Heart Foundation video explains what atrial fibrillation is and how it affects the heart.

Does nicotine trigger AFib episodes?

This is a question many people with AF ask, and the honest answer is that no health body lists it as an episode trigger. The NHS tells people with AF to avoid triggers “such as caffeine, spicy food, stress, dehydration and lack of sleep,” and separately to not smoke. Nicotine is not on its trigger list. That is not proof that nicotine is harmless for the heart: for the wider evidence, read our review of is nicotine bad for your heart evidence and our explainer on does nicotine raise blood pressure.

If you notice your palpitations or a racing heartbeat start soon after smoking, vaping or using any nicotine product, tell your clinician. They can look at your own pattern, which no article can.

Is nicotine replacement safe with AFib?

We cannot answer this for you, and it is not an answer to guess at. What we can show is what a product label says. A US over-the-counter nicotine gum label on DailyMed says: “Ask a doctor before use if you have … heart disease, recent heart attack, or irregular heartbeat.” It also says to stop use and ask a doctor if irregular heartbeat or palpitations occur.

So the practical rule is simple. If you have AF, check with your cardiologist, GP or pharmacist before starting any nicotine replacement, and ask which product and plan suit you. Do not stop a prescribed heart medicine such as an anticoagulant because you are quitting; your treatment is separate. A clinician may also have other stop-smoking options to discuss.

Questions to take to your next appointment

• Given my AF and my other medicines, which stop-smoking aids are suitable for me?
• If I use nicotine replacement, which form and dose should I start with, and what should make me stop?
• Should I track my pulse or symptoms during the first weeks of quitting, and how?
• Do any of my current heart medicines need checking when I stop smoking?
• Who should I contact if palpitations get worse while I am quitting?

Writing the answers down helps, because the first weeks of a quit attempt are busy and stressful, and it is easy to forget what was agreed.

Stroke risk with AFib and smoking

The main danger of AF is not the palpitations but the clots. The NHS says treatment should help manage symptoms and lower the risk of complications such as blood clots, stroke and heart failure, and that medicines may include anticoagulants to lower the risk of blood clots or stroke.

Does quitting help once you have AF? A 2021 Korean database study in the Journal of Clinical Medicine followed 97,637 patients with newly diagnosed AF. About 6.9 percent stopped smoking after diagnosis. Compared with current smokers, those quitters had lower risks of ischemic stroke (hazard ratio 0.702, 95 percent confidence interval 0.595 to 0.827) and of death from any cause (hazard ratio 0.842, 95 percent CI 0.748 to 0.948). The authors wrote: “Quitting smoking may reduce the risk of ischemic stroke, the severity of ischemic stroke, and the incidence of cerebrovascular events in patients with new-onset AF.”

This was an observational analysis, so it shows an association, not proof. For more on clot risk, see the blood clots article linked above, and if you have had a cardiac event, our guide to quitting smoking after a heart attack.

What changes after you quit

A 2024 analysis of the UK Biobank in JACC: Clinical Electrophysiology looked at whether the risk of AF can be modified. It followed 146,772 participants, of whom 3,966 quit smoking during the study, for a mean of 12.7 years. After adjusting for age, sex, body mass index, cardiovascular conditions, alcohol and pack-years, the risk of AF was 13 percent lower in former smokers (hazard ratio 0.87, 95 percent CI 0.83 to 0.91) and 18 percent lower in people who quit during the study (hazard ratio 0.82, 95 percent CI 0.70 to 0.95), compared with current smokers. The authors concluded: “Compared to those who continue to smoke, smoking cessation was associated with a lower risk of AF.”

Together, these two analyses say the same thing from different angles: former smokers carry less excess risk than current smokers, and the difference between former and never smokers is small. For the full picture of what recovers and when, see our what happens when you quit smoking complete health recovery guide, and for success numbers, quit smoking success rates statistics.

Other steps the NHS lists for living with AF

Quitting is one part of looking after your heart rhythm. The NHS also suggests avoiding triggers such as caffeine, spicy food, stress, dehydration and lack of sleep, trying to keep to a healthy weight, eating a balanced diet and exercising regularly, aiming for at least 150 minutes of moderate exercise a week such as walking, bike riding or gardening. It advises not drinking too much alcohol and not exercising too much or too hard, because that can trigger AF. Check with your doctor about what exercise suits you.

When to call 999

The NHS says to call 999 if you currently have a fast or irregular heartbeat and any of these: chest pain, shortness of breath, sweating, feeling or being sick, fainting or dizziness, a severe headache, weakness or numbness on one side of your face or body, blurred vision or loss of sight, or confusion or difficulty speaking. Do not drive yourself to A&E. See a GP if you have palpitations that keep happening or are getting worse.

The free iQuit app can help with the quitting itself: you can pick cold turkey or gradual reduction, log each craving with its trigger and intensity, and use SOS tools when an urge hits. It tracks smoke-free days and money saved. iQuit supports quitting; it does not monitor heart rhythm, diagnose or treat AF, and heart-rate information here comes from medical sources, not the app.

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