The mnemonic for causes of new-onset atrial fibrillation is "PIRATES", which stands for: Pulmonary embolism, Ischemic heart disease, Rheumatic valvular disease, Atrial myxoma, Thyroid disease, Embolism, Sepsis/surgery/sleep apnea.
- P – Pulmonary causes (e.g., pulmonary embolism, chronic lung disease)
- I – Ischaemic heart disease (coronary artery disease, myocardial infarction)
- R – Rheumatic heart disease (e.g., mitral stenosis)
- A – Atrial myxoma (rare cardiac tumor)
- T – Thyroid dysfunction (hyperthyroidism, thyrotoxicosis)
- E – Embolism (stroke, systemic embolism)
- S – Sepsis (severe infections leading to systemic inflammation)
Another helpful mnemonic for remembering common AF causes is SMITH:
- S – Sepsis
- M – Mitral valve disease (stenosis or regurgitation)
- I – Ischaemic heart disease
- T – Thyrotoxicosis (excess thyroid hormones)
- H – Hypertension (one of the most significant risk factors)
Other conditions: Obstructive sleep apnea, Hypertension, Diabetes mellitus, Thyroid disease, Obesity, Alcohol abuse, Excessive sports practice, Inflammation, Neurologic disorders, and Hemodynamic stress.
Risk factors:
- Increasing age: Age is one of the strongest predictors of AF, with prevalence increasing significantly after age 60.
- Cardiac or thoracic surgery: Post-operative AF can occur after cardiac surgeries (e.g., coronary artery bypass grafting, valve repair or replacement).
- Other atrial arrhythmias: Conditions like atrial flutter, atrial tachycardia, and other types of supraventricular tachycardia (SVT) can increase the likelihood of developing AF.
- Previous stroke/transient ischaemic attack: Individuals who have experienced a stroke or TIA are at a higher risk of AF, as these events are often related to underlying embolic or thrombotic factors that increase the likelihood of abnormal heart rhythms.
- COPD: COPD is often associated with increased pulmonary pressure and atrial enlargement, both of which are predisposing factors for AF.
- Smoking: Smoking increases the risk of AF by promoting systemic inflammation and oxidative stress, which can cause changes to the heart's electrical conduction pathways.
Managing triggers: deep breathing, vagal maneuvers (bearing down), and staying hydrated.
Quick Tips:
- Managing AFib involves modifying risk factors, controlling heart rate, preventing blood clots (anticoagulation), and restoring heart rhythm.
- AFib is diagnosed when an irregular atrial rhythm lasts more than 30 seconds on an ECG.
- The different types of AFib include paroxysmal, persistent, long-standing persistent, and permanent, classified based on duration and response to treatment.
- An ECG showing an irregularly irregular rhythm with no P waves confirms AFib.
