Atrial Fibrillation

Epidemiology

Age

The Incidence of Atrial Fibrillation Increases with Age in Males (Am J Med, 1995) [MEDLINE]

Etiology/Risk Factors

Genetic Factors

Family History of Atrial Fibrillation
Polygenic Risk Factors
Monogenic Risk Factors
- XXXX

Congenital Heart Disease

Atrial Septal Defect (ASD) (see Atrial Septal Defect)
Ebstein Anomaly (see Ebstein Anomaly)
Patent Ductus Arteriosus (PDA) (see Patent Ductus Arteriosus)
Post-Surgical Correction of Various Congenital Heart Diseases
- Pulmonic Stenosis (see Pulmonic Stenosis)
- Tetralogy of Fallot (see Tetralogy of Fallot)
- Transposition of the Great Vessels
- Ventricular Septal Defect (VSD) (see Ventricular Septal Defect)

Endocrinologic Disease

Diabetes Mellitus (see Diabetes Mellitus)
- Epidemiology: xxxxxxx
Hyperthyroidism (see Hyperthyroidism)
- Epidemiology: xxxxxxx
Metabolic Syndrome
- Epidemiology: xxxxxxx
Obesity (BMI >30) (see Obesity)
- Epidemiology: xxxxxxx

Infectious Disease

Influenza Virus (see Influenza Virus)
- Epidemiology
  - Influenza Virus Infection Results in an 18% Increase in the Risk of Atrial Fibrillation (Heart Rhythm, 2016) [MEDLINE]
Pneumococcal Pneumonia (see Streptococcus Pneumoniae)
- Epidemiology
  - Pneumococcal Pneumonia Increases the Risk of Cardiac Events (Myocardial Infarction, Arrhythmia, New/Worsening CHF) (Clin Infect Dis, 2007) [MEDLINE]
Rheumatic Heart Disease (see Rheumatic Fever)
- Epidemiology: xxxxxxx
Sepsis (see Sepsis)
- Epidemiology
  - New-Onset Atrial Fibrillation Has Been Reported to Occur in Approximately 5.9% of Patients with Severe Sepsis (JAMA, 2011) [MEDLINE]
  - New Onset Atrial Fibrillation Has Been Reported to Occur in Approximately 7% of Patients with Critical Illness (Crit Care Med, 2015) [MEDLINE]

Pulmonary Disease

Acute Pulmonary Embolism (PE) (see Acute Pulmonary Embolism)
- Epidemiology
  - XXXX
  - Scandinavian Tromso Study of the Association Between Venous Thromboembolism and Atrial Fibrillation (J Am Heart Assoc, 2014) [MEDLINE]
    - Venous Thromboembolism was Associated with an Increased Future Risk of Atrial Fibrillation: 9.3% developed subsequent atrial fibrillation
    - Risk of Atrial Fibrillation was Particularly High in the First 6 Months After the Venous Thomboembolism Event (Hazard Ratio 4.00, 95% CI: 2.21-7.25) and in Those with Pulmonary Embolism (Hazard Ratio 1.78, 95% CI: 1.13-2.8)
- Physiology
  - Increased Pulmonary Vascular Resistance (PVR), Resulting in Increased RV Afterload and RA Strain
Chronic Obstructive Pulmonary Disease (COPD) (see Chronic Obstructive Pulmonary Disease)
- Epidemiology
  - Copenhagen City Heart Study Examining the Association Between Decreased Lung Function and the Risk of Atrial Fibrillation (Eur Respir J, 2003) [MEDLINE]
    - Presence of COPD Increases the Risk of Atrial Fibrillation
Obstructive Sleep Apnea (OSA) (see Obstructive Sleep Apnea)
- Epidemiology
  - There is an Association Between Obstructive Sleep Apnea and Atrial Fibrillation (Circulation, 2004) [MEDLINE]

Renal Disease

Chronic Kidney Disease (CKD) (see xxxx)
- Epidemiology: xxxx

Surgery

Cardiac Surgery
- Epidemiology
Cardiac Transplantation (see xxxx)
- Epidemiology
Non-Cardiac Surgery
- Epidemiology

Valvular Heart Disease

Mitral Regurgitation (MR) (see Mitral Regurgitation)
- Epidemiology: xxxx
Mitral Stenosis (see Mitral Stenosis)
- Epidemiology: xxxx

Other Cardiac Disease

Congestive Heart Failure (CHF) (see Congestive Heart Failure)
- Epidemiology
  - Atrial Fibrillation and Congestive Heart Failure Often Occur Together (and Frequently Predispose to the Development of the Other Condition)
congenital long QT syndrome (see xxxx)
- Epidemiology
Coronary Artery Disease (CAD) (see Coronary Artery Disease)
- Epidemiology
  - Hypertensive Heart Disease and Coronary Artery Disease are the Most Common Risk Factors for Atrial Fibrillation in Developed Countries
  - However, Coronary Artery Disease is Typically Only Associated with the Development of Atrial Fibrillation When it Results in Myocardial Infarction or Congestive Heart Failure (CHF) (see Congestive Heart Failure)
Hypertensive Heart Disease (see Hypertension)
- Epidemiology
  - Hypertensive Heart Disease and Coronary Artery Disease are the Most Common Risk Factors for Atrial Fibrillation in Developed Countries (NEJM, 1982) [MEDLINE]
  - Hypertension Increases the Risk of Atrial Fibrillation 1.42-Fold (in Males) (Am J Med, 1995) [MEDLINE]
Hypertrophic Cardiomyopathy (see Hypertrophic Cardiomyopathy)
- Epidemiology
Idiopathic Pericarditis (see xxxx)
Long P-Wave Duration
- Epidemiology
Lupus Myocarditis (see Systemic Lupus Erythematosus)
Paroxysmal Supraventricular Tachycardia (PSVT) (see xxxx)
- Epidemiology: the most common causes of PSVT are atrioventricular nodal re-entrant tachycardia and atrioventricular reentrant tachycardia, which occurs in patients with the Wolff-Parkinson-White syndrome or concealed accessory pathways
Pericardial (Epicardial) Fat
- Epidemiology
Peripartum Cardiomyopathy (see xxxx)
Premature Atrial Contractions (PAC’s)
- Epidemiology
Ruptured Sinus of Valsalva Aneurysm (see Sinus of Valsalva Aneurysm)
Short QT syndrome (see xxxx)
Uremic Pericarditis (see xxxx)
Wolff-Parkinson-White Syndrome (see xxxx)

Drug/Toxin

Adenosine (see xxxx)
Air Pollution
- Epidemiology:
Bisphosphonates (see xxxx)
- Agents: alendronate, risedronate, etidronate
- Epidemiology: unclear association with atrial fibrillation
Corticosteroids (see Corticosteroids)
- Epidemiology
  - Reported in adults receiving pulse-dose corticosteroids for multiple sclerosis (see Multiple Sclerosis) [MEDLINE]
Digoxin (see xxxx)
- Pharmacology: due to increased vagal tone inducing atrial fibrillation
Ethanol (see xxxx)
- Epidemiology
Methamphetamine Intoxication (see Methamphetamine)
Nonsteroidal Anti-Inflammatory Drugs (NSAID’s) (see Nonsteroidal Anti-Inflammatory Drug)
- Class Effect: common to all NSAID’s (including selective COX-2 inhibitors)
- Meta-Analysis of 5 Studies Examining the Association Between NSAID’s Use and the Incidence of Atrial Fibrillation (Am J Cardiol, 2014): overall, non-aspirin NSAID use was associated with a 12% increased risk of atrial fibrillation [MEDLINE]
  - Relative Risk was 1.53 (95% CI: 1.37-1.70) Among New Non-Aspirin NSAID Users
- Physiology: may be explained by the presence of congestive heart failure and/or renal disease
Propofol Infusion Syndrome (see Propofol)
Theophylline (see Theophylline)
xxx
xxx
xxx

Other

Athletic Male
- Physiology
  - Vagally-mediated AF is often seen in athletic young men without apparent heart disease who have slow heart rates during rest or sleep; such patients may also have an electrocardiogram (ECG) pattern of typical atrial flutter alternating with AF
Exercise
- Physiology
  - XXXXXX
Higher Birth Weight
Hypomagnesemia (see Hypomagnesemia)

Clinical Manifestations

General Comments

Asymptomatic in Some Cases

Cardiovascular Manifestations

Elevated Serum Troponin (see Serum Troponin): due to supply-demand mismatch
Hypotension (see Hypotension): particularly with rapid ventricular response
Palpitations (see Palpitations)
Chest Pain (see Chest Pain)
Falls/Syncope (see Syncope)
- Systematic Review and Meta-Analysis of Studies of Syncope and AF (Mayo Clin Proc, 2020) [MEDLINE]: n = 10
  - AF is Independently Associated with Falls (Odds Ratio 1.19, 95% CI: 1.07-1.33, p = 0.001) and Syncope (Odds Ratio 1.88, 95% CI: 1.20-2.94, p = 0.006) in Older Adults

Other Manifestations

Systemic Embolization

Epidemiology
- Study of New-Onset Atrial Fibrillation in Severe Sepsis (JAMA, 2011) [MEDLINE]
  - Patients with New-Onset AF and Severe Sepsis are at 4x Increased Risk of In-Hospital CVA and a 7% Increased Risk of Death, as Compared with Patients with No AF and Patients with Preexisting AF
  - Possible Mechanisms for Increased Risk of CVA in New-Onset AF in Severe Sepsis: new-onset AF might just be a marker for the sickest patients with greatest inherent CVA risk, sepsis itself might result in an increased risk for CVA (by hemodynamic collapse, coagulopathy, or systemic inflammation), or new-onset AF might be a source of cardioembolic CVA
  - Patients with Severe Sepsis Had a 6x Increased Risk of In-Hospital CVA, as Compared with Hospitalized Patients without Severe Sepsis
  - Patients with Severe Sepsis and Preexisting AF Did Not Have an Increased Risk of CVA, as Compared with Patients without AF
Clinical
- Acute Limb Ischemia (see Acute Limb Ischemia)
- Ischemic Cerebrovascular Accident (CVA) (see Ischemic Cerebrovascular Accident)

Treatment

Rate Control with Atrio-Ventricular (AV) Nodal Blocking Agents

Beta Blockers (see β-Adrenergic Receptor Antagonists)

Atenolol (Tenormin) (see Atenolol)
Bisoprolol (Concor, Zebeta) (see Bisoprolol)
Carvedilol (Coreg) (see Carvedilol)
Esmolol (Brevibloc) (see Esmolol)
Labetalol (Normodyne, Trandate) (see Labetalol)
Metoprolol (Lopressor) (see Metoprolol)
Nebivolol (Bystolic) (see Nebivolol)
Propafenone (Rhythmol) (see Propafenone): with additional Class 1C antiarrhythmic properties (inhibits sodium channels)
Propanolol (Inderal) (see Propanolol)
Sotalol (Betapace, Betapace AF, Sotalex, Sotacor) (see Sotalol): with additional Class III antiarrhythmic properties (inhibits potassium channels)

Calcium Channel Blockers with AV Nodal Blocking Activity (see Calcium Channel Blockers)

Diltiazem (Cardizem, Tiazac, Dilt-CD) (see Diltiazem)
Verapamil (Isoptin, Verelan, Verelan PM, Calan, Bosoptin, Covera-HS) (see Verapamil)

Other

Digoxin (see Digoxin)

Stroke Prevention

Anticoagulation

CHADS2 Scoring
- Congestive Heart Failure (CHF)
- Hypertension
- Age ≥75 y/o
- Diabetes Mellitus
- *Prior Stroke or Transient Ischemic Attack
Agents
- Coumadin (see Coumadin)
  - Coumadin Interruption for Surgery/Procedures
    - BRIDGE Trial Studying Peri-Operative Low Molecular Weight Heparin Bridge Therapy in Atrial Fibrillation Patients on Coumadin with Planned Interruption for Surgery/Procedures (NEJM, 2015) [MEDLINE]: in atrial fibrillation with coumadin interrupted for elective surgery/invasive procedure, forgoing low molecular weight heparin bridge therapy decreased the rate of bleeding and was non-inferior to using low molecular weight heparin bridge therapy for the prevention of arterial thromboembolism
- Factor IIa (Thrombin) Inhibitors (see Factor IIa Inhibitors)
  - Dabigatran (Pradaxa) (see Dabigatran)
- Factor X Inhibitors (see Factor Xa Inhibitors)
  - Apixaban (Eliquis) (see Apixaban)
  - Edoxaban (Lixiana) (see Edoxaban)
  - Rivaroxaban (Xarelto) (see Rivaroxaban)

Lip GYH, Keshishian AV, Zhang Y. Oral Anticoagulants for nonvalvular atrial fibrillation in patients with high risk of gastrointestinal bleeding. JAMA Network Open. Published online August 16, 2021. doi:10.1001/jamanetworkopen.2021.20064 [MEDLINE]

Recommendations for Atrial Fibrillation (Including Paroxysmal Atrial Fibrillation/Atrial Flutter) Alone (Chest 2012 Antithrombotic Therapy and Prevention of Thrombosis Guidelines) [MEDLINE]
- Low Risk of Stroke (CHADS2 Score = 0): no therapy is recommended (Grade 2B Recommendation)
  - For Patients Who Chose Antithrombotic Therapy, Aspirin (75-325 mg qday) is Suggested Over Anticoagulation (Grade 2B Recommendation) or Dual Anti-Platelet Therapy (Aspirin and Clopidogrel) (Grade 2B Recommendation)
- Intermediate Risk of Stroke (CHADS2 Score = 1): oral anticoagulation is recommended (Grade 1B Recommendation vs No Therapy)
  - Dabigatran (150 mg BID) is Recommended Over Coumadin (Grade 2B)
  - For Patients Who Decline/Are Unable to Take Oral Anticoagulation (for Reasons Other Than Major Bleeding), Dual Anti-Platelet Therapy (Aspirin and Clopidogrel) is Suggested (Grade 2B Recommendation vs Aspirin Alone)
- High Risk of Stroke (CHADS2 Score = 2): oral anticoagulation is recommended (Grade 1A Recommendation vs No Therapy)
  - Dabigatran (150 mg BID) is Recommended Over Coumadin (Grade 2B)
  - For Patients Who Decline/Are Unable to Take Oral Anticoagulation (for Reasons Other Than Major Bleeding), Dual Anti-Platelet Therapy (Aspirin and Clopidogrel) is Recommended (Grade 1B Recommendation vs Aspirin Alone)
Recommendations for Atrial Fibrillation (Including Paroxysmal Atrial Fibrillation/Atrial Flutter) with Mitral Stenosis (Chest 2012 Antithrombotic Therapy and Prevention of Thrombosis Guidelines) [MEDLINE]
- Atrial Fibrillation with Mitral Stenosis: coumadin is recommended (Grade 1B Recommendation)
  - For Patients Who Decline/Are Unable to Take Coumadin (for Reasons Other Than Major Bleeding), Dual Anti-Platelet Therapy (Aspirin and Clopidogrel) is Recommended (Grade 1B Recommendation vs Aspirin Alone)
Recommendations for Atrial Fibrillation (Including Paroxysmal Atrial Fibrillation/Atrial Flutter) with Stable Coronary Artery Disease (Chest 2012 Antithrombotic Therapy and Prevention of Thrombosis Guidelines) [MEDLINE]
- Atrial Fibrillation with Stable Coronary Artery Disease (No ACS within 1 Year): coumadin alone is suggested over coumadin and aspirin (Grade 2C Recommendation)
Recommendations for Atrial Fibrillation (Including Paroxysmal Atrial Fibrillation/Atrial Flutter) with Acute Coronary Syndrome without Coronary Artery Stenting (Chest 2012 Antithrombotic Therapy and Prevention of Thrombosis Guidelines) [MEDLINE]
- Intermediate-High Risk of Stroke (CHADS2 Score ≥1) with Acute Coronary Syndrome without Coronary Artery Stenting
  - First 12 mo: coumadin and single anti-platelet therapy is recommended (Grade 2C Recommendation)
  - After 12 mo (same as for AF with stable coronary artery disease): coumadin alone is recommended
- Low Risk of Stroke (CHADS2 Score 0) with Acute Coronary Syndrome without Coronary Artery Stenting
  - First 12 mo: dual-anti-platelet therapy is recommended (Grade 2C Recommendation)
  - After 12 mo (same as for AF with stable coronary artery disease): coumadin alone is recommended
Recommendations for Atrial Fibrillation (Including Paroxysmal Atrial Fibrillation/Atrial Flutter) with Coronary Artery Stenting (Chest 2012 Antithrombotic Therapy and Prevention of Thrombosis Guidelines) [MEDLINE]
- Low-Intermediate Risk of Stroke (CHADS2 Score = 0-1) During the First 12 mo After Bare Metal Stent or Drug-Eluting Coronary Artery Stenting
  - First 12 mo: dual anti-platelet therapy (aspirin + clopidogrel) is suggested over triple therapy (Grade 2C Recommendation)
  - After 12 mo (same as for AF with stable coronary artery disease): coumadin alone is recommended
- High Risk of Stroke (CHADS2 Score = 2) During the First 1 mo After Bare Metal Stent or During the First 3-6 mo After Drug-Eluting Coronary Artery Stenting
  - Initial Period: triple therapy with coumadin + aspirin + clopidogrel is recommended (Grade 2C Recommendation)
  - After the Initial Period: coumadin + single anti-platelet therapy is recommended (Grade 2C)
  - After 12 mo (same as for AF with stable coronary artery disease): coumadin alone is recommended
Recommendations for Atrial Fibrillation (Including Paroxysmal Atrial Fibrillation/Atrial Flutter) Being Managed with a Rhythm Control Strategy (Pharmacologic or Catheter Ablation) (Chest 2012 Antithrombotic Therapy and Prevention of Thrombosis Guidelines) [MEDLINE]
- Antithrombotic Therapy Should Follow Above Recommendations for Atrial Fibrillation, Despite the Apparent Persistence of Normal Sinus Rhythm
Recommendations for Atrial Fibrillation (Including Paroxysmal Atrial Fibrillation/Atrial Flutter) in Relation to Pharmacologic of Electrical Cardioversion (Chest 2012 Antithrombotic Therapy and Prevention of Thrombosis Guidelines) [MEDLINE]
- Atrial Fibrillation/Flutter Documented to be Present for <48 hrs: therapeutic anticoagulation is recommended on presentation with cardioversion (Grade 2C Recommendation)
  - Continue Anticoagulation for at Least 4 wks After Successful Cardioversion, Regardless of Baseline Risk of Stroke (Grade 2C Recommendation)
- Atrial Fibrillation/Flutter Present for >48 hrs or Unknown Duration: therapeutic anticoagulation for at least 3 wks prior to cardioversion (or a transesophageal echocardiogram-guided approach with abbreviated anticoagulation) are recommended (Grade 1B Recommendation)
  - Continue Anticoagulation for at Least 4 wks After Successful Cardioversion, Regardless of Baseline Risk of Stroke (Grade 1B Recommendation)
- Atrial Fibrillation/Flutter Requiring Urgent Cardioversion (for Hemodynamic Instability): therapeutic anticoagulation is recommended before cardioversion (if possible) (Grade 2C Recommendation)
  - Continue Anticoagulation for at Least 4 wks After Successful Cardioversion, Regardless of Baseline Risk of Stroke (Grade 2C Recommendation)

Watchman Left Atrial Appendage Exclusion Device (see Watchman Left Atrial Appendage Closure Device)

Indications
- Presence of Contraindication to Anticoagulation
Technique (Interventional Cardiology): femoral venous access -> trans-septal puncture -> deployment of device into left atrial appendage
Complications
- Pericardial Tamponade (see Tamponade)

Cardioversion

Electrical Cardioversion

AF <48 hrs: synchronized conversion (120-200 J) without anticoagulation
AF >48 hrs: anticoagulation x 2 wks, then conversion (if TEE shows no clots, conversion is safe without anticoagulation).
Risk Factors for Recurrent AF After Conversion: age and gender are not risk factors for recurrence
- EF <40%
- LA >3.9 cm: long axis

Chemical/Pharmacologic Cardioversion

Amiodarone (Nexterone, Cordarone) (see Amiodarone)
Dronedarone (Multaq) (see Dronedarone): significantly reduces the risk for hospitalization due to cardiovascular events or death in patients with paroxysmal or persistent AF or flutter
- Efficacy: decreases death rate from cardiac arrhythmia
- Adverse Effects
  - Increased creatinine, without change in renal function (due to partial inhibition of tubular organic cation transporters)
  - Low incidence of thyroid and pulmonary toxicity

Atrioventricular (AV) Nodal Ablation (see xxxx)

Indications
- xxx
Complications
- xxxx

Treatment of Concomitant Obstructive Sleep Apnea (OSA) (see Obstructive Sleep Apnea)

Use of CPAP (>4 hrs/nt) in OSA patients with AF has been shown to decrease risk of recurrent AF after cardioversion (42% recurrence rate vs. 82% recurrence rate):
May be related to effects of OSA on nocturnal hypoxemia, hypercapnia, sympathetic drive, and changes in intrathoracic pressure

Management of Atrial Fibrillation in the Setting of Sepsis (see Sepsis)

Clinical Efficacy

Retrospective Cohort Study of Practice Patterns in the Management of Atrial Fibrillation During Sepsis (Chest, 2016) [MEDLINE]: n = 39,693
- While Calcium Channel Blockers were the Frequently Used Intravenous Medications for Atrial Fibrillation During Sepsis, β-Blockers were Associated with Superior Clinical Outcomes (In-Hospital Mortality Rate) in the Subgroups Analyzed: results were similar among subgroups with new-onset vs pre-existing AF, heart failure, vasopressin-dependent shock, or hypertension
Multicenter Retrospective Cohort Study of the Treatment of Sepsis-Associated Atrial Fibrillation with Rapid Ventricular Response (with Heart Rate > 110 beats/min) (Chest, 2020) [MEDLINE]: n = 666
- In the Study, 50.6% Initially Received Amiodarone, 33.8% Received a Calcium Channel Blocker, 10.1% Received a β-Blocker, and 5.6% Received Digoxin
- Adjusted Hazard Ratio for Heart Rate of <110 beats/min by 1 hr
  - Amiodarone vs β-Blocker: 0.50 (95% CI; 0.34-0.74)
  - Digoxin vs β-Blocker: 0.37 (95% CI; 0.18-0.77)
  - Calcium Channel Blocker vs β-Blocker: 0.75 (95% CI; 0.51-1.11)
- Adjusted Hazard Ratio for Heart Rate of <110 beats/min by 6 hrs
  - Amiodarone vs β-Blocker: : 0.67 (95% CI, 0.47-0.97)
  - Digoxin vs β-Blocker: 0.60 (95% CI, 0.36-1.004)
  - Calcium Channel Blocker vs β-Blocker: 1.03 (95% CI, 0.71-1.49)
- Conclusions
  - β-Blocker Treatment Strategy Improved Heart Rate Control at 1 hr
  - With All of the Strategies, There was Generally Similar Heart Rate Control at 6 hrs

Prognosis

Atrial Fibrillation in the Setting of Critical Illness

Clinical Data

Study of New-Onset Atrial Fibrillation in Severe Sepsis (JAMA, 2011) [MEDLINE]
- Patients with New-Onset AF and Severe Sepsis are at 4x Increased Risk of In-Hospital CVA and a 7% Increased Risk of Death, as Compared with Patients with No AF and Patients with Preexisting AF
- Possible Mechanisms for Increased Risk of CVA in New-Onset AF in Severe Sepsis: new-onset AF might just be a marker for the sickest patients with greatest inherent CVA risk, sepsis itself might result in an increased risk for CVA (by hemodynamic collapse, coagulopathy, or systemic inflammation), or new-onset AF might be a source of cardioembolic CVA
- Patients with Severe Sepsis Had a 6x Increased Risk of In-Hospital CVA, as Compared with Hospitalized Patients without Severe Sepsis
- Patients with Severe Sepsis and Preexisting AF Did Not Have an Increased Risk of CVA, as Compared with Patients without AF
Prospective Observational Study of Atrial Fibrillation as a Predictor of Increased Mortality (31% vs 17%) in Critically Ill Patients (Crit Care Med, 2016) [MEDLINE]
- AF in Critical Illness (Whether New-Onset or Recurrent) is Independently Associated with Increased Hospital Mortality, Especially in Patients without Sepsis
- New-Onset AF (But Not Recurrent AF) was Associated with Increased Diastolic Dysfunction and Vasopressor Use and a Greater Cumulative Positive Fluid Balance

References

General

Incident Stroke and Mortality Associated With New-Onset Atrial Fibrillation in Patients Hospitalized With Severe Sepsis. JAMA 2011;306(20) [MEDLINE]
Incidence of various cardiac arrhythmias and conduction disturbances due to high dose intravenous methylprednisolone in patients with multiple sclerosis. J Neurol Sci. 2011 Oct 15;309(1-2):75-8. doi: 10.1016/j.jns.2011.07.018. Epub 2011 Aug 9 [MEDLINE]
Meta-analysis of nonsteroidal anti-inflammatory drug use and risk of atrial fibrillation. Am J Cardiol. 2014 Nov 15;114(10):1523-9. doi: 10.1016/j.amjcard.2014.08.015. Epub 2014 Aug 27 [MEDLINE]
Atrial Fibrillation Is an Independent Predictor of Mortality in Critically Ill Patients. Crit Care Med. 2015 Oct;43(10):2104-11. doi: 10.1097/CCM.0000000000001166 [MEDLINE]

Epidemiology/Risk Factors

A re-evaluation of electrocardiographic changes accompanying acute pulmonary embolism. Am J Med Sci. 1966;251(4):381 [MEDLINE]
Epidemiologic features of chronic atrial fibrillation: the Framingham study. N Engl J Med. 1982;306(17):1018 [MEDLINE]
Atrial fibrillation. Cause and time of onset. Arch Intern Med. 1989;149(2):457 [MEDLINE]
The natural history of atrial fibrillation: incidence, risk factors, and prognosis in the Manitoba Follow-Up Study. Am J Med. 1995;98(5):476 [MEDLINE]
Sleep-disordered breathing: a novel predictor of atrial fibrillation after coronary artery bypass surgery. Coron Artery Dis. 1996;7(6):475 [MEDLINE]
Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet. 1999;353(9162):1386 [MEDLINE]
Obstructive sleep apnea and the recurrence of atrial fibrillation. Circulation. 2003;107(20):2589. Epub 2003 May 12 [MEDLINE]
Reduced lung function and risk of atrial fibrillation in the Copenhagen City Heart Study. Eur Respir J. 2003;21(6):1012 [MEDLINE]
Association of atrial fibrillation and obstructive sleep apnea. Circulation. 2004;110(4):364. Epub 2004 Jul 12 [MEDLINE]
Nocturnal atrial fibrillation in a patient with obstructive sleep apnoea. Thorax. 2005;60(2):174 [MEDLINE]
The association between pneumococcal pneumonia and acute cardiac events. Clin Infect Dis. 2007;45(2):158 [MEDLINE]
Is atrial fibrillation associated with pulmonary embolism? J Thromb Haemost. 2012 Mar;10(3):347-51 [MEDLINE]
Venous thromboembolism increases the risk of atrial fibrillation: the Tromso study. J Am Heart Assoc. 2014;3(1):e000483. Epub 2014 Jan 2 [MEDLINE]
The association between influenza infection, vaccination, and atrial fibrillation: A nationwide case-control study. Heart Rhythm. 2016 Jun;13(6):1189-94. Epub 2016 Feb 2 [MEDLINE]

Clinical

Atrial Fibrillation Is Associated With Syncope and Falls in Older Adults: A Systematic Review and Meta-analysis. Mayo Clin Proc. 2020 Apr;95(4):676-687. doi: 10.1016/j.mayocp.2019.09.029 [MEDLINE]

Treatment

Dronedarone: a new antiarrhythmic agent. Drugs Today 2006;42:75-86 [MEDLINE]
Effect of dronedarone on cardiovascular events in atrial fibrillation. N Engl J Med 2009;360:668-678 [MEDLINE]
Executive summary: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012 Feb;141(2 Suppl):7S-47S. doi: 10.1378/chest.1412S3 [MEDLINE]
Antithrombotic therapy for atrial fibrillation: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012 Feb;141(2 Suppl):e531S-75S. doi: 10.1378/chest.11-2304 [MEDLINE]
Efficacy and safety of the novel oral anticoagulants in atrial fibrillation: a systematic review and meta-analysis of the literature. Circulation. 2012;126:2381–2391 [MEDLINE]
Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. Lancet. 2014;383:955–962 [MEDLINE]
BRIDGE Trial. Perioperative Bridging Anticoagulation in Patients with Atrial Fibrillation. N Engl J Med. 2015;373(9):823 [MEDLINE]
Use and outcomes associated with bridging during anticoagulation interruptions in patients with atrial fibrillation: findings from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF). Circulation. 2015;131:488–494 [MEDLINE]
Heparin bridging in warfarin anticoagulation therapy initiation could increase bleeding in non-valvular atrial fibrillation patients: a multicenter propensity-matched analysis. J Thromb Haemost. 2015;13:182–190 [MEDLINE]
Practice Patterns and Outcomes of Treatments for Atrial Fibrillation During Sepsis: A Propensity-Matched Cohort Study. Chest. 2016 Jan;149(1):74-83. doi: 10.1378/chest.15-0959. Epub 2016 Jan 6 [MEDLINE]
Comparative Effectiveness of Heart Rate Control Medications for the Treatment of Sepsis-Associated Atrial Fibrillation. Chest. 2020 Oct 24;159(4):1452-1459. doi: 10.1016/j.chest.2020.10.049 [MEDLINE]
Oral Anticoagulants for nonvalvular atrial fibrillation in patients with high risk of gastrointestinal bleeding. JAMA Network Open. Published online August 16, 2021. doi:10.1001/jamanetworkopen.2021.20064 [MEDLINE]