II. Risk Factors
- Mnemonic: "Atrial Fib"
- Alcohol Abuse
- Thyroid Disease
- Rheumatic Heart Disease
- Ischemic Heart Disease or Myocardial Infarction
- Atrial Myxoma
- Lung (Pulmonary Embolism, Emphysema)
- Pheochromocytoma
- Idiopathic
- Blood Pressure (Hypertension)
- Hypertension and its control is the most important risk factor for Atrial Fibrillation
- Other Risk Factors
- Increasing age
- Age >70 years: Relative Risk 7 (compared with age <50 years)
- Obesity
- Diabetes Mellitus
- Smoking
- Congestive Heart Failure
- Obstructive Sleep Apnea
- Increasing age
III. Causes: Cardiopulmonary
- Chronic cardiac conditions (especially when accompanied by Left Ventricular Hypertrophy)
- Congestive Heart Failure
- Ischemic Heart Disease (Myocardial Infarction)
- No direct association with Atrial Fibrillation
- Supraventricular Arrhythmia is uncommon in ACS
- New onset Atrial Fibrillation/flutter does not require MI rule-out, unless history and exam suggests
- Hypertension
- Valvular heart disease (e.g. Rheumatic Heart Disease with Mitral Stenosis)
- Acute or Transient conditions
- Pericarditis
- Myocarditis
- Acute Pulmonary Embolism
- Pneumonia
- Sepsis or other shock state
- Miscellaneous conditions
- Obesity
- Risk increased 1.5 fold over non-obese patients
- Risk increases additionally with increased BMI
- Wang (2004) JAMA 292(20): 2471-7 [PubMed]
- Chronic Obstructive Pulmonary Disease
- Obstructive Sleep Apnea
- Cardiac Surgery
- Post-ablation, catheterization or device implant
- Cardiac Pacemaker
- Open thoracic surgery
- Sick Sinus Syndrome
- Atrial Myxoma (rare)
- Endurance athletes
- Moderate Exercise (3.5 hours/week) decreases Atrial Fibrillation frequency and burden
- However, high volume Exercise (>3 hours/day) increases Atrial Fibrillation risk
- Paroxysmal Atrial Fibrillation is at increased risk in endurance athletes (esp. males, and athletes who started at a young age)
- Self-cardioversion with aerobic Exercise (ventricular rates above a. fib rate) has been documented in endurance athletes
- Moderate Exercise (3.5 hours/week) decreases Atrial Fibrillation frequency and burden
- Structural heart defects
- Cardiomyopathy
- Persistent Atrial Septal Defects and other Congenital Heart Disease
- Obesity
- Lone Atrial Fibrillation
- Patient under age 60 years
- No precipitating cause identified
- Responsible for 30-45% of paroxysmal Atrial Fibrillation and 20-25% of persistent Atrial Fibrillation
IV. Causes: Toxic, metabolic and Electrolyte disorders
-
Alcohol Abuse
- May be the cause of 66% of cases under age 65 years old
- Binge weekend drinking may result in paroxysmal Atrial Fibrillation (holiday heart syndrome)
- Sympathetic medication triggers
- Cocaine
- Amphetamine
- Caffeine
- Diet pills (e.g. Ephedra)
- Beta agonist Inhalers
- Lithium
- Prolonged QT Interval due to Medication
- Metabolic Disorders
- Miscellaneous
- Electrolyte abnromalities
- Omega-3 Fatty Acid
- Associated with higher doses (esp. 4 grams/day, but increased risk linearly at >1 g/day)
- Huh (2023) Korean J Intern Med 38(3):282-9 +PMID: 36514212 [PubMed]
V. References
- Casaletto (2014) Crit Dec Emerg Med 28(4): 10-19
- Gutierrez (2017) Am Fam Physician 83(1): 61-8 [PubMed]
- Jung (1998) Am J Med 104:272 [PubMed]
- Stiell (2011) Canadian J Cardiol 27(1): 38-46 [PubMed]
- Wann (2011) Circulation 123(1): 104-23 [PubMed]
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Related Studies
| Definition (CHV) | rapid tremor and shake of upper chambers of the heart |
| Definition (CHV) | rapid tremor and shake of upper chambers of the heart |
| Definition (CHV) | rapid tremor and shake of upper chambers of the heart |
| Definition (CHV) | rapid tremor and shake of upper chambers of the heart |
| Definition (CHV) | rapid tremor and shake of upper chambers of the heart |
| Definition (CHV) | rapid tremor and shake of upper chambers of the heart |
| Definition (MEDLINEPLUS) |
An arrhythmia is a problem with the speed or rhythm of the heartbeat. Atrial fibrillation (AF) is the most common type of arrhythmia. The cause is a disorder in the heart's electrical system. Often, people who have AF may not even feel symptoms. But you may feel
AF can lead to an increased risk of stroke. In many patients, it can also cause chest pain, heart attack, or heart failure. Doctors diagnose AF using family and medical history, a physical exam, and a test called an electrocardiogram (EKG), which looks at the electrical waves your heart makes. Treatments include medicines and procedures to restore normal rhythm. NIH: National Heart, Lung, and Blood Institute |
| Definition (NCI_CTCAE) | A disorder characterized by a dysrhythmia without discernible P waves and an irregular ventricular response due to multiple reentry circuits. The rhythm disturbance originates above the ventricles. |
| Definition (NCI_FDA) | An arrhythmia in which minute areas of the atrial myocardium are in various uncoordinated stages of depolarization and repolarization; instead of intermittently contracting, the atria quiver continuously in a chaotic pattern, causing a totally irregular, often rapid ventricular rate. |
| Definition (NCI) | A disorder characterized by an electrocardiographic finding of a supraventricular arrhythmia characterized by the replacement of consistent P waves by rapid oscillations or fibrillatory waves that vary in size, shape and timing and are accompanied by an irregular ventricular response. (CDISC) |
| Definition (CSP) | disorder of cardiac rhythm characterized by rapid, irregular atrial impulses and ineffective atrial contractions. |
| Definition (MSH) | Abnormal cardiac rhythm that is characterized by rapid, uncoordinated firing of electrical impulses in the upper chambers of the heart (HEART ATRIA). In such case, blood cannot be effectively pumped into the lower chambers of the heart (HEART VENTRICLES). It is caused by abnormal impulse generation. |
| Concepts | Pathologic Function (T046) |
| MSH | D001281 |
| ICD9 | 427.31 |
| SnomedCT | 155364009, 266306001, 49436004 |
| LNC | LA17084-7 |
| English | Atrial Fibrillations, Auricular Fibrillation, Auricular Fibrillations, Fibrillations, Atrial, Fibrillations, Auricular, FIBRILLATION ATRIAL, AURICULAR FIBRILLATION, Auricular fibrillation, Fibrillation, Atrial, Fibrillation, Auricular, AF, atrial fibrillation, atrial fibrillation (diagnosis), Afib, AFib, Fibrillation atrial, Atrial Fibrillation [Disease/Finding], Fibrillation;atrial, afib, atrial fibrillation (AF), auricular fibrillations, atrial fibrillations, Familial Atrial Fibrillation, Fibrillation - atrial, ATRIAL FIBRILLATION, Atrial fibrillation, AF - Atrial fibrillation, Atrial fibrillation (disorder), atrium; fibrillation, auricular; fibrillation, fibrillation; atrial or auricular, Atrial Fibrillation, auricular fibrillation |
| French | FIBRILLATION AURICULAIRE, FA, AFib, Fibrillation auriculaire, Fibrillation atriale |
| German | VORHOFFLIMMERN, AF, Afib, Flimmern Vorhof, Herzohrflimmern, HERZVORHOFFLIMMERN, Vorhofflimmern, Aurikuläres Flimmern |
| Portuguese | FIBRILACAO AURICULAR, FA, FIBRILHACAO AURICULAR, Fibrilhação auricular, Fibrilação Atrial, Fibrilação Auricular |
| Spanish | FIBRILACION AURICULAR, FA, Fibrilación atrial, AURICULAR, FIBRILACION, fibrilación auricular (trastorno), fibrilación auricular, Fibrilación auricular, Fibrilación Atrial, Fibrilación Auricular |
| Dutch | AFib, AF, atriumfibrillatie, hartoorfibrilleren, atrium; fibrilleren, auriculair; fibrilleren, fibrilleren; atrium of auriculair, atriale fibrillatie, Atriumfibrillatie, Boezemfibrillatie, Fibrillatie, atrium-, Fibrillatie, boezem-, Fibrilleren, boezem- |
| Swedish | Förmaksflimmer |
| Japanese | ｼﾝﾎﾞｳｻｲﾄﾞｳ, 心房細動, 心房性細動 |
| Finnish | Eteisvärinä |
| Russian | USHKA PREDSERDIIA FIBRILLIATSIIA, PREDSERDII FIBRILLIATSIIA, ПРЕДСЕРДИЙ ФИБРИЛЛЯЦИЯ, УШКА ПРЕДСЕРДИЯ ФИБРИЛЛЯЦИЯ |
| Czech | Fibrilace ouška, Fibrilace síní, fibrilace síní, síňová fibrilace, FiS |
| Italian | Fibrillazione auricolare, Fibrillazione atriale |
| Croatian | ATRIJ, FIBRILACIJA |
| Polish | Migotanie przedsionków |
| Hungarian | AFib, Fibrillatio atrialis, Pitvarfibrillatio |
| Norwegian | Forkammerflimmer, Hjerteflimmer, Artrieflimmer |
