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5th May 2025
Aetiology
Atrial arrhythmias are caused by a wide variety of diseases and it is useful to stratify this using a surgical sieve as in the table below. Due to this, a thorough history and examination is of paramount importance in ascertaining the cause of arrhythmia.
| Surgical sieve | Cause |
|---|---|
| Intracardiac
(Encompassing vascular, congenital, traumatic, degenerative and inflammatory causes) |
Myocardial infarction and coronary artery disease
LV aneurysm Valvular disease: particularly mitral regurgitation (MR) Most common valvular lesion responsible for AF. Pericarditis/myocarditis Aberrant conduction pathways and pre-excitation syndromes (e.g. Wolff-Parkinson-White) Sick sinus syndrome Congenital heart disease Amyloidosis Pericardial effusion |
| Infection | Systemic infection
Infective endocarditis |
| Metabolic/autonomic | Electrolyte derangement (Mg, K, Ca, Na)
Hypoxia Hypercapnia Metabolic acidosis Thyroid disease Vagal nerve dysfunction Diabetes mellitus |
| Iatrogenic | β2 agonists, digoxin, levodopa, tricyclic antidepressants, doxorubicin, catecholamines, thyroxine (list not exhaustive) |
| Dietary/lifestyle | Caffeine, alcohol, smoking, obesity
Drugs e.g. cocaine, ecstasy, amphetamines |
| Neoplastic | Thyroid adenoma – hyperthyroidism
Phaeochromocytoma – excess catecholamines Solid organ cancers metastasising to pericardium (breast, lung, malignant melanoma) Atrial myxoma Neuroendocrine tumours |
| Vascular | Pulmonary embolism |
Table 2: Causes of atrial arrhythmias.
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