Atrial Fibrillation

Clinical service organisation for adults with atrial fibrillation: Cochrane systematic review and meta-analysis.

Ferguson C, Shaikh F, Allida SM, Hendriks J, Gallagher C, Bajorek BV · European journal of cardiovascular nursing · 2025 · n=8205

This study aims to assess the effects of organized clinical service delivery models for atrial fibrillation (AF) on all-cause mortality and hospitalization, as well as cardiovascular outcomes, thromboembolic events, bleeding complications, quality of life, symptom burden, healthcare costs, and length of hospital stay. A systematic search was conducted across several databases, including Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and CINAHL, and clinical trial registries. Randomized controlled trials involving adults (≥18 years) with any type of AF were included. Primary outcomes were all-cause mortality and all-cause hospitalization. Secondary outcomes included cardiovascular mortality and hospitalization, AF-related emergency department visits, thromboembolic and bleeding events, quality of life, symptom burden, cost of intervention, and length of hospital stay. Eight studies (8205 participants) investigating collaborative, multidisciplinary, or

L-carnitine supplementation to prevent postoperative complications after cardiac surgery: A systematic review and meta-analysis of randomised clinical trials.

Shalabi L, Ibrahim A, Elsawy MA, Zreigh S, Dervis M, Elshabrawi MN · Indian journal of anaesthesia · 2025 · n=786

Cardiac surgeries often lead to postoperative complications, which affect recovery and increase morbidity and mortality. This systematic review aims to assess L-carnitine's effect on preventing postoperative complications across various cardiac surgeries, addressing gaps in current literature on its potential therapeutic benefits. We systematically searched Web of Science, Cochrane, Embase, PubMed, and Scopus databases until March 2025. Statistical analysis was performed using R version 4.3.2. Effect sizes were measured with relative risks (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes, while heterogeneity was evaluated using the I² statistic. Thirteen randomised controlled trials(RCTs) with 786 patients were included. L-carnitine significantly increased the cardiac index (CI) (MD: 0.14; 95% CI: 0.07, 0.20; P < 0.01) and left ventricular stroke work index (LVSWI) (MD: 0.42; 95% CI: 0.06, 0.78; P = 0.02). In addition, L-carnitine significantly

Left atrial appendage closure vs oral anticoagulation for stroke prevention in atrial fibrillation: Long-term outcomes from 4 randomized trials.

Kaisaier W, Xu Z, Guo L, Dong Y, Chen Y, Lip GYH · Heart rhythm · 2025 · n=3116

Left atrial appendage closure (LAAC) is primarily indicated for stroke prevention in patients with atrial fibrillation (AF) who have contraindications to long-term oral anticoagulants (OACs). However, the long-term comparative benefits of LAAC vs OACs in the broader AF population remain unclear. To study aimed to assess the long-term efficacy and safety of LAAC compared with OACs in patients with AF, we conducted a meta-analysis of randomized controlled trials (RCTs). We systematically searched PubMed, Embase, and Cochrane Library for eligible RCTs. Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using fixed-effects models. Four RCTs involving 3116 patients with AF (1736 assigned to LAAC and 1380 to OACs) and follow-up durations ranging from 36 to 49.6 months were included. Compared with OACs, LAAC was associated with reduced risks of all-cause death (RR = 0.78; 95% CI: 0.64-0.95) and cardiovascular or unexplained death (RR = 0.69; 95% CI: 0.51-0.94). There wer

Umbrella review and Delphi study on modifiable factors for dementia risk reduction.

Rosenau C, Köhler S, Soons LM, Anstey KJ, Brayne C, Brodaty H · Alzheimer's & dementia : the journal of the Alzheimer's Association · 2024

A 2013 systematic review and Delphi consensus study identified 12 modifiable risk and protective factors for dementia, which were subsequently merged into the "LIfestyle for BRAin health" (LIBRA) score. We systematically evaluated whether LIBRA requires revision based on new evidence. To identify modifiable risk and protective factors suitable for dementia risk reduction, we combined an umbrella review of systematic reviews and meta-analyses with a two-round Delphi consensus study. The review of 608 unique primary studies and opinions of 18 experts prioritized six modifiable factors: hearing impairment, social contact, sleep, life course inequalities, atrial fibrillation, and psychological stress. Based on expert ranking, hearing impairment, social contact, and sleep were considered the most suitable candidates for inclusion in updated dementia risk scores. As such, the current study shows that dementia risk scores need systematic updates based on emerging evidence. Future studies will

Clinical evidence of interventions assessed in Friedreich ataxia: a systematic review.

Jain P, Badgujar L, Spoorendonk J, Buesch K · Therapeutic advances in rare disease · 2022 · n=11

The rare inherited autosomal recessive disease Friedreich ataxia (FA) causes progressive neurodegenerative changes and disability in patients. A systematic literature review (SLR) was carried out to understand and summarize the published efficacy and safety of therapeutic interventions in this disease. Database searches were carried out in MEDLINE, Embase, and Cochrane by two independent reviewers. In addition, trial registries and conference proceedings were hand-searched. Thirty-two publications were deemed eligible according to PICOS criteria. Twenty-four publications detail randomized controlled trials. The most frequently identified therapeutic intervention was idebenone (n = 11), followed by recombinant erythropoietin (n = 6), omaveloxolone (n = 3), and amantadine hydrochloride (n = 2). Other therapeutic interventions were investigated in one publication: A0001, CoQ10, creatine, deferiprone, interferon-γ-1b, the L-carnitine levorotatory form of 5-hydroxytryptophan, luvada

Environmental and lifestyle risk factors for early-onset dementia: a systematic review.

Bosi M, Malavolti M, Garuti C, Tondelli M, Marchesi C, Vinceti M · Acta bio-medica : Atenei Parmensis · 2022

The term early-onset dementia (EOD) encompasses several forms of neurodegenerative diseases characterized by symptom onset before 65 years and leading to severe impact on subjects already in working activities, as well as on their family and caregivers. Despite the increasing incidence, the etiology is still unknown, with possible association of environmental factors, although the evidence is still scarce. In this review, we aimed to assess how several environmental and lifestyle factors may be associated with the onset of this disease. We conducted a literature search in PubMed and EMBASE databases up to May 6, 2022, to retrieve epidemiological studies evaluating the effect of environmental and lifestyle factors on EOD risk. We eventually included 22 studies, ten with cohort and twelve with case-control design. Traumatic injury, especially on the head/brain, some cardiovascular diseases such as atrial fibrillation and stroke, metabolic diseases including diabetes and hypercholestero

Guidelines on the management of atrial fibrillation

European Society of Cardiology (ESC)

TheseESC clinical practice guidelines offer evidence-based recommendations for the diagnosis and management of atrial fibrillation, covering prevention, stroke risk assessment, and therapeutic interventions. They are developed to assist healthcare professionals in making optimal decisions.

Atrial fibrillation: diagnosis and management

NICE

This guideline covers diagnosing and managing atrial fibrillation (AF) in people aged 18 and over. It aims to improve outcomes by providing recommendations on rate and rhythm control, anticoagulation, and stroke prevention.

Atrial fibrillation: diagnosis and management (CG180)

NICE

This guideline covers diagnosing and managing atrial fibrillation in adults, including recommendations on anticoagulation, rhythm control, and rate control strategies. It aims to improve outcomes and reduce the risk of stroke in people with AF.

Magnesium Supplementation and Tachyarrhythmias: A Nonrandomized Clinical Trial.

Goulden R, Abrahamowicz M, Strumpf E, Tamblyn R · JAMA internal medicine · 2026

Magnesium supplementation is regularly given to acutely ill patients with serum levels below the standard reference range, primarily for the prevention of tachyarrhythmias, such as atrial fibrillation. The evidence for this practice and the specific treatment thresholds used is limited. Conventional observational studies of this question are at risk of confounding by indication and other biases. To determine whether giving magnesium supplementation to patients with hypomagnesemia, as defined by a given institution's usual treatment cutoff, reduces adverse clinical outcome using a quasi-experimental study design that plausibly allows for causal inference. This nonrandomized clinical trial of intensive care unit (ICU) patients undergoing serum magnesium testing was conducted in 93 ICUs across the US and Europe between 2003 and 2022. A fuzzy regression discontinuity design was used, in which individuals just either side of the eligibility cutoff for magnesium supplementation were compar

Improving outcomes of atrial fibrillation ablation by integrated personalized lifestyle interventions: a randomized controlled trial.

Vermeer J, Vinck-de Greef T, van den Broek M, de Louw B, van Steenbergen G, van Veghel D · European heart journal · 2026 · n=145

Atrial fibrillation (AF) is associated with various lifestyle risk factors. Their presence negatively affects AF catheter ablation outcomes. This study evaluates the efficacy of a nurse-led, integrated lifestyle programme on ablation outcomes. POP-AF is a prospective, randomized, controlled trial involving patients referred for their first AF ablation. Patients were assigned in a 1:1 ratio to standard pre-ablation counselling by the treating electrophysiologist, or a nurse-led integrated lifestyle clinic, including a home sleep apnoea test, weight reduction, alcohol reduction, smoking cessation, and optimal hypertension and hypercholesterolaemia treatment before undergoing pulmonary vein isolation (PVI). The primary endpoint was a composite of hospitalizations for repeat ablations and direct current cardioversions in an event-rate analysis up to 12 months after pulsed-field pulmonary vein isolation. A total of 145 patients participated in the trial; 70 patients were assigned to the c

Catheter Ablation vs Lifestyle Modification With Antiarrhythmic Drugs to Treat Atrial Fibrillation: PRAGUE-25 Trial.

Osmancik P, Roubicek T, Havranek S, Chovancik J, Bulkova V, Herman D · Journal of the American College of Cardiology · 2025 · n=212

Obesity is an important risk factor for atrial fibrillation (AF). Nonrandomized studies have shown that weight loss and increased physical activity are associated with AF reduction. The goal of this study was to assess whether treatment based on lifestyle modification (LFM; directed weight loss and physical exercise) in combination with antiarrhythmic drugs (AADs) is noninferior to catheter ablation (CA) in patients with AF and obesity. In a randomized multicenter noninferiority trial, we enrolled patients with paroxysmal or persistent AF and a body mass index (BMI) of 30-40 kg/m2. Patients were randomized to the CA vs LFM+AAD groups in a 1:1 ratio. Seven-day electrocardiographic Holter recordings were performed every 3 months. The primary endpoint was AF freedom during the 12 months after randomization (ie, absence of any AF episode lasting >30 s; the blanking period was 3 months). Secondary endpoints included AF burden, peak oxygen uptake during cardiopulmonary exercise testing,

N-3 Fatty Acids (EPA and DHA) and Cardiovascular Health - Updated Review of Mechanisms and Clinical Outcomes.

Djuricic I, Calder PC · Current atherosclerosis reports · 2025

We synthesize the latest evidence (published 2020 to 2025) on the role of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in cardiovascular health, emphasizing biological mechanisms and key findings from observational studies and clinical trials related to cardiovascular disease (CVD) risk and outcomes. EPA and DHA modulate lipid metabolism, inflammation, platelet and endothelial function, the gut-heart axis, ion channels and autonomic function via vagal tone, supporting cardiovascular health. While individual RCTs have produced variable results, updated cohort data and recent meta-analyses consistently link higher intake or circulating levels of EPA and DHA to reduced risk of cardiovascular events. However, evidence from RCTs indicates that high-dose supplementation may be associated with an increase in atrial fibrillation (AF) risk. Evidence supports a role for EPA and DHA in CVD prevention and treatment, with effects influenced by dose, formulation, and individual variab

The Role of Dietary Magnesium in Cardiovascular Disease.

Nielsen FH · Nutrients · 2024

In the past 20 years, a large number of epidemiological studies, randomized controlled trials, and meta-analyses have found an inverse relationship between magnesium intake or serum magnesium and cardiovascular disease, indicating that low magnesium status is associated with hypertension, coronary artery calcification, stroke, ischemic heart disease, atrial fibrillation, heart failure, and cardiac mortality. Controlled metabolic unit human depletion-repletion experiments found that a mild or moderate magnesium deficiency can cause physiological and metabolic changes that respond to magnesium supplementation, which indicates that these types of deficiencies or chronic latent magnesium deficiency are contributing factors to the occurrence and severity of cardiovascular disease. Mechanisms through which a mild or moderate magnesium deficiency can contribute to this risk include inflammatory stress, oxidative stress, dyslipidemia and deranged lipid metabolism, endothelial dysfunction, and

L-Carnitine: A New Therapeutic Option for the Prevention of Atrial Fibrillation in Non-Cardiac Surgery-A Single-Group Interventional Pilot Study.

Shingu Y, Yokota I, Kato T, Hida Y, Kaga K, Gao J · Journal of clinical medicine · 2024

Background: L-carnitine is essential in lipid metabolism and reportedly has preventive effects for arrhythmia. Our objective was to examine the incidence of postoperative atrial fibrillation (POAF) and changes in serum biomarker levels following perioperative L-carnitine administration in patients with lung cancer. Methods: Thirteen patients undergoing a lobectomy with preoperative serum brain natriuretic peptide levels >24 pg/mL were perioperatively administered L-carnitine for 5 days (3 g/3×). Accurate 95% confidence intervals (CI) for POAF incidence were calculated. Serum biomarkers for POAF in lung cancer and target proteins for L-carnitine were evaluated by using open-source data from proteomic analysis. Results: The incidence of POAF was 38.5% (95% CI 13.9%-68.4%). Fatty acid-binding protein 4 (FABP4) was selected as a candidate biomarker from 1472, 63, and 26 proteins related to lung cancer, L-carnitine, and AF, respectively. A positive correlation was observed between t

Enhancing Fatty Acids Oxidation via L-Carnitine Attenuates Obesity-Related Atrial Fibrillation and Structural Remodeling by Activating AMPK Signaling and Alleviating Cardiac Lipotoxicity.

Zhang Y, Fu Y, Jiang T, Liu B, Sun H, Zhang Y · Frontiers in pharmacology · 2021

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in clinical setting. Its pathogenesis was associated with metabolic disorder, especially defective fatty acids oxidation (FAO). However, whether promoting FAO could prevent AF occurrence and development remains elusive. In this study, we established a mouse model of obesity-related AF through high-fat diet (HFD) feeding, and used l-carnitine (LCA, 150 mg/kg⋅BW/d), an endogenous cofactor of carnitine palmitoyl-transferase-1B (CPT1B; the rate-limiting enzyme of FAO) to investigate whether FAO promotion can attenuate the AF susceptibility in obesity. All mice underwent electrophysiological assessment for atrial vulnerability, and echocardiography, histology and molecular evaluation for AF substrates and underlying mechanisms, which were further validated by pharmacological experiments in vitro. HFD-induced obese mice increased AF vulnerability and exhibited apparent atrial structural remodeling, including

What is Atrial Fibrillation (AFib or AF)?

AHA

This page provides an overview of atrial fibrillation, including its causes, symptoms, diagnosis, and treatment options. It serves as a general resource for patients and the public to understand this common heart condition.

Atrial Fibrillation

AHA

This page from the American Heart Association provides general information about atrial fibrillation, including its causes, symptoms, diagnosis, and treatment options for the public.

A Randomized Controlled Study on the Waveform Periodicity Analysis of Complex Fractionated Electrograms in Patients With Persistent Atrial Fibrillation

n=80 · NCT05333952 · UNKNOWN · UNKNOWN

Atrial fibrillation (AF) has been the most frequently occurring, sustained arrhythmia, which causes significant morbidity and mortality. AF may not always be a totally random process. It can be maintained by stable and rapid reentrant circuits resulting in fibrillary conduction throughout the atria. During mapping of AF, difficulty is frequently encountered during the identification of culprit sites and an analysis of the wave propagation particularly when the electrogram signals demonstrate wide temporal and spatial disparities. Catheter ablation targeting regions with fractionated potentials or high frequencies during AF, has been previously proposed as a treatment strategy. However, the benefit of adjunctive CFAE (complex fractionated atrial electrogram) ablation or linear ablation after successful PVI (pulmonary vein isolation) was controversial based on the recent data from the Substrate and Trigger Ablation for Reduction of Atrial Fibrillation Trial Part II (STAR AF II) trial. Therefore, the optimal ablation strategy for persistent AF remains undetermined and an alternative approach has to be explored.

Study of Electrophysiological Effects of NACOS and AVK on the Pulmonary Veins and the Left Atrium of Patients Referred for Paroxysmal AF Catheter Ablation

n=90 · NCT02814955 · UNKNOWN · UNKNOWN

Atrial fibrillation (AF) is the most common cardiac arrhythmias with a constantly growing prevalence AF. The purpose of paroxysmal AF processing is to control outbreaks from these pulmonary veins, medicated way (antiarrhythmic) or interventional. Ablation (radiofrequency or cryotherapy) has become in this context recognized and effective treatment of AF. In addition, antithrombotic treatments in this context is a major treatments for the prevention of stroke (stroke). They are most often associated with antiarrhythmic treatment to prevent recurrence of AF or to slow it during a relapse. Recent experimental studies have highlighted the direct electrophysiological properties of dabigatran and rivaroxaban in the pulmonary veins and the left atrium. Dabigatran demonstrated in this study that it induced a prolongation of potential action in the pulmonary veins and the left atrium and it decreased the incidence of FA-induced by stimulation. Conversely, rivaroxaban induces shortening of the action potential in the left atrium (untested properties in the pulmonary veins). To our knowledge, apixaban and warfarin have not been studied in this context. It is therefore possible that some of the new oral anticoagulants (NACOS) or some AVK (fluindione and warfarin), have direct electrophysiological effects in the pulmonary veins and on the left atrium and could influence AF recurrences (with effect " antiarrhythmic-like "or rather a pro-arrhythmic effect) after ablation.A retrospective analysis conducted at the University Hospital of Caen on very low numbers suggest that patients on dabigatran would have less pulmonary veins connected in early ablation procedure that patients on warfarin or rivaroxaban. Despite the limitations inherent in this analysis (very low numbers, retrospective analysis, unique setting and having studied his own limits), these results are consistent with the fundamental studies, and thus encourage us to pursue our hypothesis to obtain more statistical power and reliability in our measurements and results. We therefore propose the study of the electrophysiological effects of NACOS (apixaban, dabigatran, rivaroxaban) and warfarin (warfarin and fluindione) on the pulmonary veins and the left atrium of patients referred for ablation of paroxysmal AF (radiofrequency or cryotherapy ) the CHU of Caen and Tours and clinic Saint Martin Caen.

Clinical Validation Study for Noninvasive Cardiopulmonary Management Device

n=141 · NCT05445726 · ACTIVE_NOT_RECRUITING · ACTIVE_NOT_RECRUITING

Subjects will be recruited and begin the study as they are identified and consent to the study. Recruiting can end when 140 subjects have initiated the study. The study does allow for additional subjects to be recruited if resources allow, leading to approximately 160 subjects. At the approximate midpoint of the study, intermediate data analysis will be performed. Enrollment will continue while this occurs. Upon arrival to the clinic on the day of the study visit, prior to the application of the reference and test devices, skin inspection of the application site will be conducted. The reference ECG device will be applied, and two initial ECGs will be taken. The precordial leads from the reference device will then be removed from the patient and the CPM Device will be applied to the participant's chest as described in the IFU materials supplied with the device (the study team will also have received training on the proper placement of the device prior to the initiation of the study). This device will be worn for the remainder of the clinic visit. On the CRF, the time that the CPM Device is placed on the chest will be denoted. The reference device and the test device will then take 2 additional ECG measurements simultaneously. During ECG measurements involving CPM device, it will be helpful to maintain silence during the entire measurement duration, as it helps the device to gather heart sounds signals without interference. The ECG results will be analyzed by certified medical personnel, where they will be asked to annotate various parameters of the ECGs. The certified medical personnel will then be asked to classify the ECGs and about the strips' clinical usability.

Cochrane Library: Atrial Fibrillation

Cochrane

The Cochrane Library provides systematic reviews and meta-analyses on various interventions for atrial fibrillation, offering high-quality evidence to inform healthcare decisions. This aggregator is a crucial resource for evidence-based medicine.