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CLINICAL STATEMENTS AND GUIDELINES

Circulation. 2024;149:e1–e156. DOI: 10.1161/CIR.0000000000001193 January 2, 2024 e15

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

L-type Ca2+ current3 and increase in IK1).4 Heterogeneity in IK1 between left and right atria further promotes arrhythmogenicity.5 Downregulation of connexin results in decreased gap junctions, leading to slow heterogeneous atrial conduction velocity and repolarization,6 promoting regional functional conduction block that can support reentry. Connexin remodeling can be due to genetic7 or acquired factors, such as inflammatory state,8,9 older age, or sleep-disordered breathing (SDB).10

Figure 4. AF Stages: Evolution of Atrial Arrhythmia Progression. *Heart failure, valve disease, coronary artery disease, hypertrophic cardiomyopathy, neuromuscular disorders, thyroid disease. Original figure created by the 2023 Atrial Fibrillation Guideline Writing Committee. AF indicates atrial fibrillation.

Table 3.  Continued

Condition Study Type Effect on Risk of AF Summary Risk of Incident AF Effect of LRFM SES Single studies Cumulative socioeconomic disadvantage: ↑ risk (HR, 1.57)94

Individual’s poorest areas: 12% ↑ d risk95 Low SES:

↑↔ risk N/A

SR/MA Heterogeneous results96

Genetics Family history/ heritability Single studies Family history of AF: ↑ risk97–99 ↑ Risk N/A

MR Proportion heritability explained by loci in European ancestry analysis, 42%100

GWAS MA Number of AF risk loci ↑s with ↑ number of subjects studied. In 2018, 97-111 loci explained ∼11%-42% of the heritability of AF in individuals of European ancestry100,101 ↑ Risk N/A

Population attributable fraction: the proportional disease incidence in the population that is estimated to be due to the risk factor.Statistically significant associations reported, unless otherwise indicated. ↓ indicates decreased; ↑, increased; ↔ no significant change in risk; AF, atrial fibrillation; ASCVD, atherosclerotic cardiovascular disease; BMI, body mass index; BNP, brain naturiuretic peptide; BP, blood pressure; CABG, coronary artery bypass graft surgery; CAD, coronary artery disease; CI, confidence interval; CKD, chronic kidney disease; DBP, diastolic blood pressure; ECG, electrocardiogram; GWAS, genome-wide association study; HF, heart failure; HR, hazard ratio; LA, left atrial; LRFM, lifestyle and risk factor modification; LV, left ventricular; LVH, left ventricular hypertrophy; MA, meta-analysis; MR, Mendelian randomization; N/A, not available/applicable; OR, odds ratio; RR, relative risk; OSA, obstructive sleep apnea; SMD, standardized mean difference; SBP, systolic blood pressure; SES, socioeconomic status; SR, systematic review; and VHD, valvular heart disease.

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