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Review
. 2026 Mar 7;407(10532):1000-1013.
doi: 10.1016/S0140-6736(25)02166-X.

Atrial fibrillation

Deirdre A Lane  1 , Jason G Andrade  2 , Elena Arbelo  3 , Giuseppe Boriani  4 , Jeroen M Hendriks  5 , So-Ryoung Lee  6 , Gregory Y H Lip  7 , Jonathan Mant  8 , Melissa E Middeldorp  9
Affiliations
Review

Atrial fibrillation

Deirdre A Lane et al. Lancet. .

Abstract

Atrial fibrillation affects approximately 37·6 million people worldwide, with the prevalence predicted to double over the next 35 years. The ubiquitous use of wearable devices and other technologies with inbuilt diagnostic algorithms allows greater detection of atrial fibrillation among the general public than previously. Atrial fibrillation increases the risk of stroke and thromboembolism, heart failure, and death, and is associated with reductions in quality of life. Patients with atrial fibrillation frequently have comorbidities, and the accumulation of risk factors, including lifestyle factors associated with poorer health outcomes, and increasing age, often adds to the complexity of managing such patients. All major clinical guidelines advocate that stroke prevention, symptom relief, identification of risk factors, and optimisation of risk factor management, incorporated into an integrated care approach, with multidisciplinary input as required, are essential elements of atrial fibrillation management. Avoidance of stroke with oral anticoagulation remains the default for most patients with atrial fibrillation and, more recently, catheter ablation has been reconsidered as an initial treatment option for symptom relief. The dynamic nature of risk factors requires early identification and appropriate management of new and existing risk factors to optimise atrial fibrillation care. Patient-centred care and better health literacy can empower patients to take a more active role in their atrial fibrillation management.

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Conflict of interest statement

Declaration of interests DAL reports investigator-initiated quality improvement grants from Bristol Myers Squibb and Pfizer (paid to institution); and is a co-applicant on the AFFIRMO project on multimorbidity in atrial fibrillation (grant agreement number 899871), the ARISTOTELES project on artificial intelligence for management of chronic long-term conditions (grant agreement number 101080189), and the TARGET project on digital twins for personalised management of atrial fibrillation and stroke (grant agreement number 101136244), all of which are funded by the Horizon Europe Research and Innovation programme. JGA reports consulting fees from Medtronic, Boston Scientific, Johnson & Johnson, and Kardium. EA reports speaker fees from Bristol Myers Squibb, Daiichi Sankyo, Boston Scientific and Medtronic and consulting fees from Boston Scientific, Bristol Myers Squibb and Cytokinetics; and is chair of the Data Monitoring Committee of the AFFIRMO project on multimorbidity in atrial fibrillation (grant agreement number 899871). GB reports speaker fees from Bayer, Boston Scientific, Daiichi Sankyo, iRhythm, Lilly, Janssen, and Sanofi outside of the submitted work; and is the principal investigator of the ARISTOTELES project that received funding from the European Union within the Horizon 2020 Research and Innovation programme (grant agreement number 101080189). JMH reports speaker fees from Medtronic and Biotronik. S-RL reports speaker fees from Medtronic, Biotronik, Boston Scientific, Abbott, Biosense Webster, Daiichi Sankyo, Bayer, Bristol Myers Squibb–Pfizer, ChongKunDang, Daewoong Pharmaceutical Co, Samjinpharm, and Seers Technology; and participation in advisory board for Medtronic, Daiichi Sankyo, and ChonKunDang; and participation in advisory board for Daiichi Sankyo (no fees received personally). GYHL is a National Institute for Health and Care Research (NIHR) Senior Investigator; is consultant and speaker for Bristol Myers Squibb–Pfizer, Boehringer Ingelheim, Daiichi Sankyo, and Anthos (no fees received personally); and is co-principal investigator of the AFFIRMO project on multimorbidity in atrial fibrillation (grant agreement number 899871), TARGET project on digital twins for personalised management of atrial fibrillation and stroke (grant agreement number 101136244) and ARISTOTELES project on artificial intelligence for management of chronic long term conditions (grant agreement number 101080189), which are all funded by the Horizon Europe Research and Innovation programme. JM is Chief Investigator of NIHR funded trial of screening for atrial fibrillation (SAFER), has received honorarium from Bristol Myers Squibb–Pfizer; and is an independent chair of the Data Safety Monitoring Board of the CRAFT trial (testing different blood pressure targets in atrial fibrillation), with no payment received for this role. MEM declares no competing interests.

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