Atrial Fibrillation Causes

Aka: Atrial Fibrillation Causes, Atrial Fibrillation Associated Conditions, Atrial Fibrillation Etiology, Atrial Fibrillation Risk Factors

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II. Risk Factors

  1. Mnemonic: "Atrial Fib"
    1. Alcohol Abuse
    2. Thyroid Disease
    3. Rheumatic Heart Disease
    4. Ischemic Heart Disease or Myocardial Infarction
    5. Atrial Myxoma
    6. Lung (Pulmonary Embolism, Emphysema)
    7. Pheochromocytoma
    8. Idiopathic
    9. Blood Pressure (Hypertension)
      1. Hypertension and its control is the most important risk factor for Atrial Fibrillation
  2. Other Risk Factors
    1. Increasing age
      1. Age >70 years: Relative Risk 7 (compared with age <50 years)
    2. Obesity
    3. Diabetes Mellitus
    4. Smoking
    5. Congestive Heart Failure
    6. Obstructive Sleep Apnea

III. Causes: Cardiopulmonary

  1. Chronic cardiac conditions (especially when accompanied by Left Ventricular Hypertrophy)
    1. Congestive Heart Failure
    2. Ischemic Heart Disease (Myocardial Infarction)
      1. No direct association with Atrial Fibrillation
      2. Supraventricular Arrhythmia is uncommon in ACS
      3. New onset Atrial Fibrillation/flutter does not require MI rule-out, unless history and exam suggests
    3. Hypertension
    4. Valvular heart disease (e.g. Rheumatic Heart Disease with Mitral Stenosis)
  2. Acute or Transient conditions
    1. Pericarditis
    2. Myocarditis
    3. Acute Pulmonary Embolism
    4. Pneumonia
    5. Sepsis or other shock state
  3. Miscellaneous conditions
    1. Obesity
      1. Risk increased 1.5 fold over non-obese patients
      2. Risk increases additionally with increased BMI
      3. Wang (2004) JAMA 292(20): 2471-7 [PubMed]
    2. Chronic Obstructive Pulmonary Disease
    3. Obstructive Sleep Apnea
    4. Cardiac Surgery
      1. Post-ablation, catheterization or device implant
      2. Cardiac Pacemaker
      3. Open thoracic surgery
    5. Sick Sinus Syndrome
    6. Atrial Myxoma (rare)
    7. Endurance athletes
      1. Moderate Exercise (3.5 hours/week) decreases Atrial Fibrillation frequency and burden
        1. However, high volume Exercise (>3 hours/day) increases Atrial Fibrillation risk
      2. Paroxysmal Atrial Fibrillation is at increased risk in endurance athletes (esp. males, and athletes who started at a young age)
        1. Stergiou (2018) Curr Treat Options Cardiovasc Med 20(12):98 +PMID: 30367267 [PubMed]
      3. Self-cardioversion with aerobic Exercise (ventricular rates above a. fib rate) has been documented in endurance athletes
        1. Ragozzino (2002) N Engl J Med 347(25):2085-6 +PMID: 12490699 [PubMed]
    8. Structural heart defects
      1. Cardiomyopathy
      2. Persistent Atrial Septal Defects and other Congenital Heart Disease
  4. Lone Atrial Fibrillation
    1. Patient under age 60 years
    2. No precipitating cause identified
    3. Responsible for 30-45% of paroxysmal Atrial Fibrillation and 20-25% of persistent Atrial Fibrillation

IV. Causes: Toxic, metabolic and Electrolyte disorders

  1. Alcohol Abuse
    1. May be the cause of 66% of cases under age 65 years old
    2. Binge weekend drinking may result in paroxysmal Atrial Fibrillation (holiday heart syndrome)
  2. Sympathetic medication triggers
    1. Cocaine
    2. Amphetamine
    3. Caffeine
    4. Diet pills (e.g. Ephedra)
    5. Beta agonist Inhalers
    6. Lithium
    7. Prolonged QT Interval due to Medication
  3. Metabolic Disorders
    1. Hyperthyroidism
    2. Hypothyroidism
    3. Pheochromocytoma
  4. Miscellaneous
    1. Electrolyte abnromalities
    2. Omega-3 Fatty Acid
      1. Associated with higher doses (esp. 4 grams/day, but increased risk linearly at >1 g/day)
      2. Huh (2023) Korean J Intern Med 38(3):282-9 +PMID: 36514212 [PubMed]

V. References

  1. Casaletto (2014) Crit Dec Emerg Med 28(4): 10-19
  2. Gutierrez (2017) Am Fam Physician 83(1): 61-8 [PubMed]
  3. Jung (1998) Am J Med 104:272 [PubMed]
  4. Stiell (2011) Canadian J Cardiol 27(1): 38-46 [PubMed]
  5. Wann (2011) Circulation 123(1): 104-23 [PubMed]

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