Causes of Atrial Fibrillation Mnemonic: PIRATES, SMITH

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.