aetiology and pathophysiology of atrial fibrillation

see also:

• cardiology
• cardiac arrhythmias
• atrial flutter
• atrial fibrillation
• Pre-excitation syndrome such as WPW
• see Detailed Mx of the patient with AF in the ED

• lifestyle interventions, including weight loss and improved physical activity, have been shown to decrease AF risk in obese individuals.

• most AF is related to high blood pressure, diabetes, and heart disease
• ~22% risk is genetic¹⁾
  • both rare and common genetic variants contribute to AF susceptibility
  • > 100 common variants associated with AF
  • individually rare, high-impact variants
  • protein-altering LMNA variants (PAVs) which encode the nuclear envelope protein Lamin A/C
    • these are associated with conduction system disease, AF, ventricular arrhythmias, and dilated cardiomyopathy
    • AF is highly prevalent and an early manifestation in LMNA-associated cardiomyopathy
• hyperthyroidism
• hypothyroidism
• valvular heart disease
• ethanol (alcohol and alcohol withdrawal) - binge or regular drinking
• high caffeine intake or other stimulants
• smoking
• hypertension
• ischaemic heart disease (IHD)
• stress and anxiety
• dehydration
• strenuous exertion
• obesity and metabolic syndrome
  • plays major roles in the pathophysiology of AF and its associated complications by inducing systemic changes, including altered haemodynamics, heightened sympathetic tone, and a persistent low-grade inflammatory state ²⁾
• obstructive sleep apnoea (OSA)
• congenital heart defects
• cardiomyopathy
• pericarditis
• viral infections
• sepsis / septicaemia
• cardiac surgery
• lung diseases including COPD, pneumonia, lung cancer
• diabetes mellitus
• chronic renal failure
• increasing age over 60yrs
• FH AF

• role of adipokines
  • Angiopoietin-like protein 2, Fibroblast growth factor 21, Lipocalin, Vaspin, Visfatin, and Nesfatin-1 play major roles in AF pathogenesis ³⁾