aetiology and pathophysiology of atrial fibrillation

Introduction

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⁾

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