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CLINICAL STATEMENTS AND GUIDELINES

January 2, 2024 Circulation. 2024;149:e1–e156. DOI: 10.1161/CIR.0000000000001193 e14

Joglar et al 2023 Guideline for the Diagnosis and Management of Atrial Fibrillation

Table 3.  Continued

(Continued )

Condition Study Type Effect on Risk of AF Summary Risk of Incident AF Effect of LRFM Markers on ECG PR interval SR/MA Prolonged PR: ↑ risk (RR, 1.45)77 Prolonged PR: ↑ risk

PR interval polygenic risk score: ↓ risk PR interval risk SNPs: variable ↑↓ risk N/A

MR Polygenic risk score PR interval prolongation: ↓ AF risk (OR, 0.95; P=4.30×10−8) with some variants associated with ↑ and some with ↓ AF risk78

LVH Single study ECG LVH: Population attributable fraction 10.4% ↓ d over time to 1.8%26 ↑ Risk N/A

SR/MA LVH: ↑ risk (RR, 1.46)79

Biomarkers Natriuretic peptides MA BNP: ↑ risk (HR per 1-SD ln-BNP, 1.66)80 ↑↔ Risk N/A

MR Natriuretic peptides not associated81

Inflammatory markers SR/MA CRP: ↑ risk (SMD, 0.95)82

IL-6: ↑ risk (SMD, 0.89)82 TNF-α: ↑ risk (SMD, 2.20)82 CRP, IL-6, TNF-α, DUSP13, FKBP7, Spondin-1: ↑ risk

IL-6R, TNFS12: ↓ risk N/A

MR DUSP13, FKBP7, Spondin-1 ↑ risk33

IL-6R, TNFS12 ↓ risk33

Lp(a) SR/MA Lp(a): HR, 1.03; only 39% of Lp(a) risk mediated via ASCVD83 ↑ Risk N/A

MR Genetically predicted ↑ Lp(a): ↑ risk (HR per 23 mg/dL genetically predicted ↑ Lp(a), 1.04)83

Imaging markers LA size or function Single studies LA anterior-posterior dimension: ↑ risk (HR per 5 mm ↑, 1.39)84

End diastolic LA volume (min): ↑ risk (HR, 1.12)85 LA emptying fraction: ↑ risk (HR, 1.03)85 ↑ LA size, emptying fraction: ↑ risk Surgical LA reduction in conjunction with cardiac surgery or surgical AF ablation in patients with persistent AF may ↑ rates of sinus rhythm86–89

MR Genetic susceptibility to AF (independent measure) is associated with ↑indexed LA size and ↓ LA ejection

fraction (dependent measures)90

LV wall thickness Single study LV posterior wall thickness: ↑ risk (HR per 4-mm ↑, 1.28)84 ↑ Risk N/A

SR/MA LVH: ↑ risk (RR, 1.46)79

Social determinants of health Education Single studies Higher education: ↑ lifetime risk of AF (US-based ARIC study)91

Higher education in young individuals: ↓ risk of AF diagnosis (Danish study)92 Variable ↑↓ risk N/A

MR AF risk related but largely mediated via BMI (57.5%), type 2 diabetes (9.8%), SBP (18.7%), and smoking (7.1%)93

Income Single studies Higher income: ↑ lifetime risk of AF (US-based ARIC study)91

Higher income in young individuals: ↓ risk of AF diagnosis (Danish study)92 Variable ↑↓ risk N/A

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