The mechanisms of atrial fibrillation in hyperthyroidism
Open accessAbstract
Atrial fibrillation (AF) is a complex condition with several possible contributing factors. The rapid and irregular heartbeat produced by AF increases the risk of blood clot formation inside the heart. These clots may eventually become dislodged, causing embolism, stroke and other disorders. AF occurs in up to 15% of patients with hyperthyroidism compared to 4% of people in the general population and is more common in men and in patients with triiodothyronine (T3) toxicosis. The incidence of AF increases with advancing age. Also, subclinical hyperthyroidism is a risk factor associated with a 3-fold increase in development of AF. Thyrotoxicosis exerts marked influences on electrical impulse generation (chronotropic effect) and conduction (dromotropic effect). Several potential mechanisms could be invoked for the effect of thyroid hormones on AF risk, including elevation of left atrial pressure secondary to increased left ventricular mass and impaired ventricular relaxation, ischemia resulting from increased resting heart rate, and increased atrial eopic activity. Reentry has been postulated as one of the main mechanisms leading to AF. AF is more likely if effective refractory periods are short and conduction is slow. Hyperthyroidism is associated with shortening of action potential duration which may also contribute to AF.
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Hyperthyroidism is linked to increased supraventricular ectopic activity.
“Hyperthyroidism is linked to increased supraventricular ectopic activity (76).”
From Thyroid Hormones and Cardiovascular Function and Diseases (2018) · cites this paper as [76]
Experimental studies show that thyroid hormone excess can provoke paroxysmal atrial fibrillation by increasing triggered activity in pulmonary veins.
“Experimental studies have shown that TH excess can provoke the occurrence of paroxysmal AF by increasing triggered activity in pulmonary veins (76)”
From Thyroid Hormones and Cardiovascular Function and Diseases (2018) · cites this paper as [76]
Reduced interatrial action potential duration facilitates atrial fibrillation by enhancing the spread of ectopic activity from the left atrium.
“The reduced interatrial action potential duration facilitates the occurrence of AF by enhancing the spreading of ectopic activity from the left atrium (76).”
From Thyroid Hormones and Cardiovascular Function and Diseases (2018) · cites this paper as [76]
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References 66 · Cited by 121
Research works printed but not linked: 1
- Mohr-Kahaly S Kahaly G Meyer J Cardiovascular involvement in thyroid disease Z Kardiol 1996 85 219 231 9064969
- Authors
- Bielecka-Dabrowa, A., Mikhailidis, D. P., Rysz, J., & Banach, M.
- Affiliations
- Medical University of Lodz (PL)
- The Royal Free Hospital (GB)
- Corresponding author
- Banach, Maciej
- Venue
- Thyroid Research
- Published
- 2009-04-02
- Volume
- 2
- Issue
- 1
- Pages
- 4-4
- ISSN
- 1756-6614 (ISSN-L)
- PMC
- PMC2680813
- OpenAlex
- W2096578639
- Cited by
- 121
- References
- 66
- Citations by year
- 2026: 7 · 2025: 8 · 2024: 8 · 2023: 9 · 2022: 6 · 2021: 14 · 2020: 8 · 2019: 5 · 2018: 6 · 2017: 12 · 2016: 2 · 2015: 7 · 2014: 5 · 2013: 10 · 2012: 6
- FWCI
- 3.02
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Thyroid Research (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Keywords
- atrial fibrillation, hyperthyroidism, thyrotoxicosis, subclinical hyperthyroidism, triiodothyronine, action potential duration, effective refractory period, left atrial pressure, left ventricular mass, ventricular relaxation, stroke risk, cardiac conduction
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