From the Guidelines
New onset atrial fibrillation (AF) is most commonly caused by cardiovascular conditions such as hypertension, coronary artery disease, heart failure, and valvular heart disease, as well as non-cardiovascular conditions like hyperthyroidism, alcohol consumption, and certain medications, as reported in the most recent study 1. The causes of new onset atrial fibrillation can be multifactorial, and it is essential to identify the underlying cause to provide effective management.
- Cardiovascular conditions associated with the development of AF include hypertension, coronary artery disease, heart failure, and valvular heart disease, as stated in 1.
- Non-cardiovascular conditions that can trigger AF include hyperthyroidism, alcohol consumption, especially binge drinking or "holiday heart syndrome", and certain medications, such as some bronchodilators, antiarrhythmics, and cancer therapies, as mentioned in 1 and 1.
- Other important causes of AF include acute infections, stimulant use, electrolyte abnormalities, obstructive sleep apnea, obesity, diabetes, and chronic lung diseases like COPD, as reported in 1.
- Acute triggers can include surgery, especially cardiac surgery, acute myocardial infarction, pericarditis, pulmonary embolism, and severe stress, as stated in 1 and 1.
- Certain medications can also trigger AF, including those listed in 1, which provides a comprehensive review of drug-induced atrial fibrillation.
- Identifying the underlying cause of AF is crucial for effective management, as treating the primary condition may help restore normal rhythm, as emphasized in 1 and 1.
From the Research
Causes of New Onset Atrial Fibrillation
- Atrial fibrillation (AF) is associated with poor outcomes, including a high risk of stroke and other thromboembolic events, especially in patients with heart failure (HF) and coronary artery disease 2.
- The risk factors for new-onset AF include:
- Older age (≥ 65 years) 2, 3
- Lower left ventricular ejection fraction (LVEF < 35%) 2, 3
- History of percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) 2
- White race 2
- Systolic blood pressure (SBP) < 110 mmHg 2
- Higher body mass index (BMI ≥ 25 kg/m2) 2
- Hypertension 3, 4
- Previous valvular heart disease 3
- Larger left atrial diameter 3
- Significant mitral regurgitation 3
- Pulmonary hypertension (PH) is also a significant risk factor for new-onset AF, as it can lead to hemodynamic stress and right heart disease 5, 6.
- Other modifiable risk factors for AF include smoking, obesity, sedentary lifestyle, and diabetes mellitus 5, 4.
- The use of dual antiplatelet therapy (DAPT) has been associated with a lower risk of new-onset AF 2.