What are the possible reversible and irreversible causes of atrial fibrillation in individuals of all ages?

Comprehensive List of Atrial Fibrillation Causes for Word Search

Reversible/Acute Causes

The following conditions represent potentially reversible triggers for atrial fibrillation that may resolve with treatment of the underlying condition, though long-term follow-up data suggest AF may still recur even after effective treatment 1.

Endocrine and Metabolic

• Hyperthyroidism (requires mandatory thyroid function testing in all newly diagnosed AF patients - Class I recommendation) 1, 2
• Electrolyte abnormalities (hypokalemia, hypomagnesemia) 3
• Dehydration 3

Acute Cardiac Events

• Myocardial infarction 1, 2
• Pericarditis 1, 2
• Myocarditis 1
• Cardiothoracic surgery (postoperative AF is a common early complication) 1, 2

Acute Non-Cardiac Medical Conditions

• Pneumonia 1, 2
• Pulmonary embolism 1, 2
• Electrocution 1

Substance-Related

• Binge drinking/acute alcohol intake (Holiday Heart Syndrome - most cases convert spontaneously to sinus rhythm within 24 hours) 1, 3, 2
• Chronic excessive alcohol use 2

Other Reversible Triggers

• Sleep deprivation 4
• Emotional stress 4
• Underlying tachyarrhythmias (Wolff-Parkinson-White syndrome, AV nodal reentrant tachycardia, atrial ectopic tachycardia - may resolve after catheter ablation) 1

Irreversible/Chronic Structural Causes

These conditions create permanent structural and electrical remodeling characterized by atrial fibrosis, enhanced connective tissue deposition, local conduction heterogeneities, and atrial dilation 2.

Valvular Heart Disease

• Mitral valve disease (particularly mitral stenosis and mitral regurgitation - strongly correlated with left atrial enlargement) 2, 5
• Mitral valve prolapse (without significant regurgitation) 5
• Mitral annulus calcification 5
• Rheumatic valvular disease 6

Cardiomyopathies

• Hypertrophic cardiomyopathy 2, 5
• Dilated cardiomyopathy 2, 5, 7
• Restrictive cardiomyopathies 2
• Cardiac amyloidosis 5
• Hemochromatosis 5
• Endomyocardial fibrosis 5
• Alcoholic cardiomyopathy (20-26% of heavy drinkers develop dilated cardiomyopathy within 5 years) 3

Hypertensive Heart Disease

• Hypertension (most commonly encountered risk factor with 1.8-fold increase in new-onset AF) 1, 2, 5, 7
• Left ventricular hypertrophy 1, 5, 7
• Prehypertension 8
• Increased pulse pressure 1, 8

Ischemic Heart Disease

• Coronary artery disease (particularly in older patients, males, and those with left ventricular dysfunction) 2, 5, 7, 8
• Prior myocardial infarction with atrial involvement 8

Heart Failure

• Heart failure with reduced ejection fraction (creates arrhythmogenic substrate through structural and electrical remodeling with extensive atrial fibrosis) 1, 2, 5, 7
• Heart failure with preserved ejection fraction/diastolic dysfunction 8
• Decreased left ventricular fractional shortening 1

Congenital Heart Disease

• Atrial septal defect (most common congenital cause in adults) 5, 7, 8
• Other congenital heart defects 8

Cardiac Tumors

• Atrial myxoma 5, 7
• Pheochromocytoma 5

Atrial Structural Abnormalities

• Left atrial enlargement 1, 2, 5
• Idiopathic dilated right atrium 5

Systemic/Non-Cardiac Chronic Conditions

Metabolic and Endocrine (Chronic)

• Diabetes mellitus (present in 20% of AF patients, requiring medical treatment) 2, 5, 7, 8
• Obesity (found in 25% of AF patients, increases risk through left atrial dilation with graded increase as BMI rises) 1, 2, 8

Pulmonary Disease

• Obstructive sleep apnea (contributes through apnea-induced increases in atrial pressure, atrial size, and autonomic changes) 1, 2, 8
• Chronic obstructive pulmonary disease (found in 10-15% of AF patients) 2, 7

Renal Disease

• Chronic kidney disease (present in 10-15% of AF patients) 2

Inflammatory Conditions

• Systemic inflammation (elevated C-reactive protein) 1, 8
• Pericardial fat 8

Demographic and Genetic Factors

Non-Modifiable Risk Factors

• Advancing age (strongest predictor - prevalence increases from <0.5% at ages 40-50 years to 5-15% at age 80 years) 1, 2, 5, 7, 8
• Male sex 2, 5, 8
• European ancestry 1, 2
• Family history 1, 2
• Genetic variants (monogenic and polygenic) 1, 8

Lifestyle and Behavioral Factors

Modifiable Risk Factors

• Smoking/tobacco use 1, 8
• High-level physical training/endurance exercise 1, 8
• Sedentary lifestyle (implied by obesity association) 2

Idiopathic/Lone Atrial Fibrillation

• Lone atrial fibrillation (occurs in approximately 30% of cases without detectable organic heart disease, after excluding hyperthyroidism, chronic obstructive lung disease, overt sinus node dysfunction, and overt or concealed preexcitation) 5, 7

Important Clinical Notes

The population-attributable risk analysis demonstrates that 56% of AF cases could be explained by one or more common modifiable risk factors, suggesting prevention through blood pressure control, weight loss, and management of other risk factors may reduce AF incidence 1, 2.

Caffeine and coffee consumption do NOT increase AF risk and may actually be protective at moderate to high intake levels (3-4 cups daily), though energy drinks should be avoided due to high caffeine loads plus other cardiac stimulants 4.