Tiny Tips: Causes of Atrial Fibrillation

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Atrial fibrillation is the most common arrhythmia encountered and managed in the emergency department.​​1,2​ In addition to ensuring hemodynamic stability and subsequent management of the arrhythmia, the emergency physician must identify and treat potential underlying causes. Atrial fibrillation itself may be a sequela of an underlying life-threatening disease process such as pulmonary embolism or sepsis. In some instances, treatment of the underlying cause may lead to the resolution of the arrhythmia.​​1​ It is therefore important to recall common triggers for atrial fibrillation. The following mnemonic, PIRATES, is a memory aid for common and/or life-threatening precipitants of atrial fibrillation that should be considered when assessing patients with atrial fibrillation.

Causes of Atrial Fibrillation: PIRATES

  • P – Pulmonary embolism
  • I – Ischemic heart disease, Inflammation (myocarditis), Idiopathic/iatrogenic
  • R – Rheumatic heart disease (mitral regurgitation or stenosis)
  • A – Alcohol (also known as holiday heart syndrome), Anemia, Atrial enlargement/myxoma, Age
  • T – Thyroid disorder (hyperthyroidism)
  • E – Electrolyte abnormalities, electrocution, exacerbation (of CHF)
  • S – Sepsis, Surgery (recent), Stimulants, Sleep apnea
  1. 1.
    Stiell I, Macle L, CCS Atrial Fibrillation Guidelines Committee. Canadian Cardiovascular Society atrial fibrillation guidelines 2010: management of recent-onset atrial fibrillation and flutter in the emergency department. Can J Cardiol. 2011;27(1):38-46. doi:10.1016/j.cjca.2010.11.014
  2. 2.
    Phang R, Olshansky B. New Onset Atrial Fibrillation. Uptodate. Published October 2019. Accessed February 2021. https://www.uptodate.com/contents/new-onset-atrial-fibrillation

This post was copyedited by Samuel Wilson (@samwilson_95).

Reviewing with the Staff

New-onset atrial fibrillation is a common presentation to the emergency department. Having a mnemonic to aid in identifying possible precipitants is beneficial for learners.

Sarah Stonehocker
Dr. Sarah Stonehocker in an Emergency Physician at Trillium Health Partners Mississauga. She is a lecturer at the University of Toronto\'s Department of Community and Family Medicine, and the Undergraduate Medical Education Lead for her emergency department. No conflicts of interest.
Barrett Grattan

Barrett Grattan

Barrett Grattan is a family medicine resident at the University of Toronto, Mississauga Hospital Site. His interests include emergency medicine, simulation learning, and medical education. In his free time, he makes repeated attempts at tennis and golf, is an avid musician, and has enjoyed chess long before The Queen's Gambit.
Barrett Grattan

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