Can an irregular heartbeat lead to erectile dysfunction? Men with atrial fibrillation have it more often: in a pooled analysis of five studies, 57% of people with atrial fibrillation had erectile dysfunction. Part of that link comes from causes the two conditions share, such as high blood pressure, diabetes, obesity, smoking and sleep apnoea. The studies show an association, and one large one found it after allowing for other risk factors, but none shows that the heart rhythm itself causes erection problems.
How common is erectile dysfunction in atrial fibrillation?
Common. A meta-analysis of five observational studies with 27,841 patients put the prevalence of erectile dysfunction in atrial fibrillation at 57%, and found atrial fibrillation linked to a higher risk of it (Chokesuwattanaskul et al., 2018). In one Polish study of 129 men with atrial fibrillation, average age 57, 57.4% had erectile dysfunction, 44.2% had problems with orgasm and 69.0% had lower sexual desire; 86.8% had at least one kind of sexual problem (Platek et al., 2016).
Does atrial fibrillation cause ED, or the other way round?
Neither is proven. In Taiwan, 3,853 men with atrial fibrillation developed erectile dysfunction at 20.6 per 10,000 person-years against 12.5 in 15,405 men without it, and atrial fibrillation remained a risk factor after other factors were allowed for (Lin et al., 2015). The other direction is mixed. In a US study of 1,760 older men, atrial fibrillation appeared within 4 years in 9.6% of those with erectile dysfunction and 2.9% of those without (Tanaka et al., 2020), while a matched study of Taiwanese men with erectile dysfunction found no higher rate of atrial fibrillation (Liu et al., 2016). Studies of this kind show links, not causes.
What do the two conditions have in common?
Many of the same causes. You are more likely to develop atrial fibrillation with type 2 diabetes, high blood pressure, obesity, smoking or heavy drinking, obstructive sleep apnoea, or heart problems such as coronary heart disease or heart failure (healthdirect — atrial fibrillation). High blood pressure, diabetes, cardiovascular disease, obesity, sleep disorders, smoking and alcohol are on healthdirect's list of causes of erectile dysfunction too (healthdirect — ED). The Polish researchers put the high rate "in part" down to those classic risk factors (Platek et al., 2016). ED is also often an early sign of heart disease: can heart problems cause erectile dysfunction?
Can atrial fibrillation medicines affect erections?
Some can. Atrial fibrillation is treated with medicines that restore a normal rhythm or slow the heart rate, and often with blood thinners to reduce the chance of a stroke (healthdirect — atrial fibrillation). Beta-blockers are one kind: the atenolol leaflet lists treating "irregular heart rhythm or beat called arrhythmias" among its uses and "sexual problems" among its side effects (Noten CMI). See do beta-blockers cause erectile dysfunction? and can blood thinners cause erectile dysfunction? If you suspect a medicine, talk to your doctor and do not stop it or change the dose on your own (Heart Foundation).
Can you take Viagra or Cialis with atrial fibrillation?
Your doctor decides, and the two leaflets differ. The Australian Cialis leaflet says not to use it with "arrhythmias (change in rhythm or rate of heart beat)" (Cialis CMI); the European label rules it out with uncontrolled arrhythmias (EMA — Cialis). Atrial fibrillation is among the rare side effects reported with sildenafil (EMA — Viagra), and the Viagra leaflet lists an unusual heartbeat as a reason to call your doctor straight away (Viagra CMI). The full answer, with the blood thinners: can Viagra be used with atrial fibrillation? and Xarelto with Viagra or Cialis.
Does a healthy lifestyle help both?
The same steps are on both lists. For atrial fibrillation, healthdirect advises staying active, losing weight if you are overweight, not smoking or vaping, no more than 3 alcoholic drinks a week, healthy blood sugar, cholesterol and blood pressure, and a test for sleep apnoea (healthdirect — atrial fibrillation). For erectile dysfunction, it says some causes can be prevented if you stop smoking, exercise more, lose weight and eat healthy food (healthdirect — ED).
The short answer
Erectile dysfunction is common in men with atrial fibrillation, but the evidence shows a link, not a cause, and the two share many risk factors. See your doctor about both: an irregular pulse needs checking, and ED can be an early sign of heart disease. Atrial fibrillation also raises the risk of stroke: can stroke patients use Viagra? For heart patients and Cialis: is Cialis safe for heart patients? Other conditions are in our guide to ED and health conditions.
