Comorbidities and differential diagnosis 

Clinicians need to be alert for illnesses and comorbidities that may contribute to or be associated with AF (Figure 11).

Common conditions liked to atrial fibrillation (brown) and co-morbidities (blue)

Figure 11. Common conditions liked to atrial fibrillation (brown) and co-morbidities (blue).2

Indeed, only between 2% and 12% of AF patients do not have underlying heart disease (previously known as lone AF).2 A quarter of AF patients have overt cardiac disease, while a third have three or more comorbidities, some of which may be risk factors for stroke.2 The ESC/EHRA guidelines offer specific guidance for AF management in people with diabetes, obesity, chronic obstructive pulmonary disease (COPD), sleep apnea, and other respiratory diseases and chronic kidney disease (CKD).5

The differential diagnosis should include non-cardiac causes of AF, such as:32

  • adverse events, such as antiarrhythmic drugs (AADs), beta-agonist bronchodilators and lithium
  • collagen vascular disease
  • electrolyte abnormalities
  • hypothermia
  • infiltrative cardiomyopathies
  • pulmonary embolism, COPD, cor pulmonale, sleep apnea and other respiratory conditions
  • supplements (such as diet pills) and illicit drugs
  • thyroid disease


Discover the burden of atrial fibrillation in the next section

Other sections to further your understanding in the disease awareness section include:

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