From the Guidelines
Hypertension is the most common cause of atrial fibrillation, as it leads to structural changes in the heart, including left atrial enlargement and ventricular hypertrophy, creating an environment conducive to the development of atrial fibrillation. According to the most recent study 1, atrial fibrillation is associated with symptoms, diminished functional capacity and quality of life, and increases the rate of all-cause hospital admissions and the risk of cardiovascular complications. The study also highlights that more than 70% of patients with atrial fibrillation are older and present structural heart diseases, such as hypertension, left atrial enlargement, coronary artery disease, heart failure, valvular heart diseases, and myocardiopathies.
Some key points to consider in the management of atrial fibrillation include:
- Controlling the underlying hypertension with medications such as ACE inhibitors, ARBs, or calcium channel blockers 1
- Using rate control medications, such as beta-blockers or calcium channel blockers, to control the heart rate
- Using rhythm control medications, such as antiarrhythmics like amiodarone, to convert the heart back to a normal rhythm
- Anticoagulation to prevent stroke, especially in patients with a high risk of thromboembolic events
- Procedures like cardioversion or catheter ablation in some cases.
It's worth noting that the study from 2024 1 provides more recent and comprehensive information on the causes and management of atrial fibrillation, and therefore, its findings should be prioritized in clinical decision-making.
From the Research
Causes of Atrial Fibrillation
- Atrial fibrillation (AF) is a common clinical problem, particularly in the elderly, and in patients with organic heart disease 2.
- The most common cause of atrial fibrillation is associated with chronic organic heart disease, including:
- Valvular heart disease
- Coronary artery disease
- Hypertension, particularly if left ventricular hypertrophy is present
- Hypertrophic cardiomyopathy
- Dilated cardiomyopathy
- Congenital heart disease
- Hypertension is the most prevalent cardiovascular risk factor underlying atrial fibrillation and is present in up to 40% of patients with atrial fibrillation 3, 4.
- Atherosclerotic coronary artery disease remains as the most common etiological factor underlying atrial fibrillation, along with systemic hypertension 5, 6.
Associated Conditions
- Other heart diseases that present a higher incidence of AF include:
- Mitral valve prolapse (with or without mitral regurgitation)
- Calcification of the mitral annulus
- Atrial myxoma
- Pheochromocytoma
- Idiopathic dilated right atrium
- The relationship between these findings and the arrhythmia are still unclear 2.