Atrial fibrillation: epidemiology and current issues (a literature review)
https://doi.org/10.15829/1560-4071-2026-6872
EDN: GKHIBW
Abstract
Atrial fibrillation remains a key public health problem due to the steadily increasing incidence and risk of severe events. The aim of this study was to conduct a comprehensive review of the current epidemiology of atrial fibrillation, analyze the evolution of risk stratification methods and diagnostic algorithms, assess the problem of left atrial appendage thrombosis in the era of direct oral anticoagulants. In addition, we systematized international management practices for patients with this condition taking direct oral anticoagulants to inform further research into solutions and improved treatment approaches.
Keywords
atrial fibrillation,
left atrial appendage thrombosis,
direct oral anticoagulants,
epidemiology,
thrombosis predictors,
stroke prevention
Supporting agencies: The authors express their sincere gratitude to A.A. Yalumov and M.S. Kirillova for their assistance in finding material and technical support during the preparation of this manuscript.
About the Authors
B. B. Ogurlieva
City Clinical Hospital № 24
Russian Federation
Competing Interests:
Russian Federation
Pistsovaya str., 10, Moscow
Competing Interests:
None
L. E. Naumova
City Clinical Hospital № 24
Russian Federation
Competing Interests:
Russian Federation
Pistsovaya str., 10, Moscow
Competing Interests:
None
M. V. Kuandykova
City Clinical Hospital № 24
Russian Federation
Competing Interests:
Russian Federation
Pistsovaya str., 10, Moscow
Competing Interests:
None
S. K. Zyryanov
Peoples’ Friendship University of Russia
Russian Federation
Competing Interests:
Russian Federation
Miklukho-Maklaya str., 6, Moscow, 117198
Competing Interests:
None
O. A. Gaidashova
City Clinical Hospital № 24
Russian Federation
Competing Interests:
Russian Federation
Pistsovaya str., 10, Moscow
Competing Interests:
None
References
1. Hindricks G, Potpara T, Dagres N, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2021;42(5):373-498. doi:10.1093/eurheartj/ehaa612.
2. Chugh SS, Havmoeller R, Narayanan K, et al. Worldwide Epidemiology of Atrial Fibrillation: A Global Burden of Disease 2010 Study. Circulation. 2014;129(8):837-47. doi:10.1161/CIRCULATIONAHA.113.005119.
3. Lippi G, Sanchis-Gomar F, Cervellin G. Global epidemiology of atrial fibrillation: An increasing epidemic and public health challenge. Int J Stroke. 2021;16(2):217-21. doi:10.1177/1747493019897870.
4. Schnabel RB, Yin X, Gona P, et al. 50 year trends in atrial fibrillation prevalence, incidence, risk factors, and mortality in the Framingham Heart Study: a cohort study. Lancet. 2015;386(9989):154-62. doi:10.1016/S0140-6736(14)61774-8.
5. Benjamin EJ, Muntner P, Alonso A, et al. Heart Disease and Stroke Statistics — 2019 Update: A Report From the American Heart Association. Circulation. 2019;139(10). doi:10.1161/CIR.0000000000000659.
6. Krijthe BP, Kunst A, Benjamin EJ, et al. Projections on the number of individuals with atrial fibrillation in the European Union, from 2000 to 2060. Eur Heart J. 2013;34(35):2746-51. doi:10.1093/eurheartj/eht280.
7. Liu SH, Chao TF. Epidemiology of Atrial Fibrillation in East Asia. JACC Asia. 2025;5(8):963-5. doi:10.1016/j.jacasi.2025.05.009.
8. Li C, Wang H, Li M, et al. Epidemiology of Atrial Fibrillation and Related Myocardial Ischemia or Arrhythmia Events in Chinese Community Population in 2019. Front Cardiovasc Med. 2022;9:821960. doi:10.3389/fcvm.2022.821960.
9. Gao MY, He L, Du X, et al. [Epidemiology of atrial fibrillation in China: 20-year trends]. Zhonghua Xin Xue Guan Bing Za Zhi. 2024;52(2):220-6. doi:10.3760/cma.j.cn112148-20231009-00277.
10. Lee SR, Kim D, Lee SH, et al. Atrial fibrillation fact sheet in Korea 2024 (part 1): epidemiology of atrial fibrillation in Korea. Int J Arrhythmia. 2024;25(1):13. doi:10.1186/s42444-024-00119-4.
11. Otabor EO, Alaka A, Onwuzo CN, et al. Exploring the Epidemiology of Atrial Fibrillation in Nigeria: A Focus on Atrial Fibrillation in Heart Failure Patients and Its Association With Stroke. Cureus. 2024;16(2):e55241. doi:10.7759/cureus.55241.
12. Oladeji OO, Ogah OS, Olunuga TO, et al. Clinical epidemiology of atrial fibrillation in heart failure in Abeokuta, Nigeria. Heart Rhythm O2. 2025;6(7):1020-7. doi:10.1016/j.hroo.2025.04.006.
13. Golukhova EZ, Golitsyn SP, Mikhailov EN, et al. 2025 Clinical practice guidelines for Atrial fibrillation and flutter. Russian Journal of Cardiology. 2025;30(11):6668. (In Russ.) doi:10.15829/1560-4071-2025-6668. EDN: MGXGON.
14. Mareev YuV, Polyakov DS, Vinogradova NG, et al. Epidemiology of atrial fibrillation in a representative sample of the European part of the Russian Federation. Analysis of EPOCH-CHF study. Kardiologiia. 2022;62(4):12-9. (In Russ.) doi:10.18087/cardio.2022.4.n1997.
15. Shapkina MYu, Mazdorova EV, Avdeeva EM, et al. Changes in the prevalence of atrial fibrillation in the Russian population over a 13-year follow-up. Cardiovascular Therapy and Prevention. 2022;21(8):3108. (In Russ.) doi:10.15829/1728-8800-2022-3108.
16. Shkolnikova MA, Jdanov DA, Ildarova RA, et al. Atrial fibrillation among Russian men and women aged 55 years and older: prevalence, mortality, and associations with biomarkers in a population-based study. J Geriatr Cardiol JGC. 2020;17(2):74-84. doi:10.11909/j.issn.1671-5411.2020.02.002.
17. Boytsov SA, Luk’yanov MM, Yakushin SS, et al. Cardiovascular diseases registry (RECVAZA): diagnostics, concomitant cardiovascular pathology, comorbidities and treatment in the real outpatient-polyclinic practice. Cardiovascular Therapy and Prevention. 2014;13(6):44-50. (In Russ.) doi:10.15829/1728-8800-2014-6-3-8.
18. Magnussen C, Niiranen TJ, Ojeda FM, et al. Sex Differences and Similarities in Atrial Fibrillation Epidemiology, Risk Factors, and Mortality in Community Cohorts: Results From the BiomarCaRE Consortium (Biomarker for Cardiovascular Risk Assessment in Europe). Circulation. 2017;136(17):1588-97. doi:10.1161/CIRCULATIONAHA.117.028981.
19. Elliott AD, Middeldorp ME, Van Gelder IC, et al. Epidemiology and modifiable risk factors for atrial fibrillation. Nat Rev Cardiol. 2023;20(6):404-17. doi:10.1038/s41569-022-00820-8.
20. Linz D, Gawalko M, Betz K, et al. Atrial fibrillation: epidemiology, screening and digital health. Lancet Reg Health Eur. 2024;37:100786. doi:10.1016/j.lanepe.2023.100786.
21. Ionin VA, Barashkova EI, Filatova AG, et al. Atrial fibrillation in St Petersburg cohort: frequency, risk factors, antiarrhythmic therapy and thromboembolism prevention. "Arterial’naya Gipertenziya" ("Arterial Hypertension"). 2020;26(2):192-201. (In Russ.) doi:10.18705/1607-419X-2020-26-2-192-201.
22. Chen G, Chen J, Zhao Q, et al. Comparative Bleeding Risk of Brand Vs Generic Rivaroxaban in Elderly Inpatients with Atrial Fibrillation. Drug Des Devel Ther. 2024;18:1573-82. doi:10.2147/DDDT.S459658.
23. Mazur ES, Mazur VV, Bazhenov ND, et al. Efficiency of the Left Atrial Appendage Thrombus Dissolution in Patients with Persistent Nonvalvular Atrial Fibrillation with Warfarin or Direct Oral Anticoagulants Therapy. Rational Pharmacotherapy in Cardiology. 2021;17(5):724-8. (In Russ.) doi:10.20996/1819-6446-2021-10-08.
24. Chen M, Li C, Liao P, et al. Epidemiology, management, and outcomes of atrial fibrillation among 30 million citizens in Shanghai, China from 2015 to 2020: A medical insurance database study. Lancet Reg Health — West Pac. 2022;23:100470. doi:10.1016/j.lanwpc.2022.100470.
25. Díaz-Guzmán J, Freixa-Pamias R, García-Alegría J, et al. Epidemiology of atrial fibrillation-related ischemic stroke and its association with DOAC uptake in Spain: first national population-based study 2005 to 2018. Rev Esp Cardiol Engl Ed. 2022;75(6):496-505. doi:10.1016/j.rec.2021.07.009.
26. Zhao Z, Zhang X. Current Status of Left Atrial Appendage Thrombus with Atrial Fibrillation. Cardiology Discovery. 2023;3(3):203-11. doi:10.1097/CD9.0000000000000095.
27. Lurie A, Wang J, Hinnegan KJ, et al. Prevalence of Left Atrial Thrombus in Anticoagulated Patients With Atrial Fibrillation. J Am Coll Cardiol. 2021;77(23):2875-86. doi:10.1016/j.jacc.2021.04.036.
28. Zeng R, Pu X, Chen S, et al. Oropharynx pain, discomfort, and economic impact of transesophageal echocardiography for planned radio-frequency catheter ablation in patients with atrial fibrillation: A cross-sectional survey study. Int J Cardiol Heart Vasc. 2023;48:101266. doi:10.1016/j.ijcha.2023.101266.
29. Zheng N, Zhang J. External validation and comparison of CHA2DS2-VASc-RAF and CHA2DS2-VASc-LAF scores for predicting left atrial thrombus and spontaneous echo contrast in patients with non-valvular atrial fibrillation. J Interv Card Electrophysiol. 2022;65(2):535-42. doi:10.1007/s10840-022-01285-y.
30. Zaigraev IA, Yavelov IS, Drapkina OM, et al. Novel scale for predicting thrombosis of the left atrium and its appendage before catheter ablation or cardioversion in patients with nonvalvular atrial fibrillation or atrial flutter. Cardiovascular Therapy and Prevention. 2023;22(5):3543. (In Russ.) doi:10.15829/1728-8800-2023-3543.
31. Van Gelder IC, Rienstra M, Bunting KV, et al. 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2024;45(36):3314-414. doi:10.1093/eurheartj/ehae176.
32. Lip GYH, Teppo K, Nielsen PB. CHA2DS2-VASc or a non-sex score (CHA2DS2-VA) for stroke risk prediction in atrial fibrillation: contemporary insights and clinical implications. Eur Heart J. 2024;45(36):3718-20. doi:10.1093/eurheartj/ehae540.
33. Melidoro P, Lip GYH, Montarello N, et al. Left Atrial Spontaneous Echo Contrast: Pathogenesis, Detection, and Modelling. Thromb Haemost. 2025; a-2688-6741. doi:10.1055/a-2688-6741.
34. Noubiap JJ, Nyaga UF, Middeldorp ME, et al. Cardiac imaging correlates and predictors of stroke in patients with atrial fibrillation: a meta-analysis. J Cardiovasc Med (Hagerstown). 2024;25(4):280-93. doi:10.2459/JCM.0000000000001608.
35. Okada M, Inoue K, Tanaka N, et al. Impact of left atrial appendage flow velocity on thrombus resolution and clinical outcomes in patients with atrial fibrillation and silent left atrial thrombi: insights from the LAT study. Europace. 2024;26(5):euae120. doi:10.1093/europace/euae120.
36. Ayirala S, Kumar S, O’Sullivan DM, et al. Echocardiographic Predictors of Left Atrial Appendage Thrombus Formation. J Am Soc Echocardiogr. 2011;24(5):499-505. doi:10.1016/j.echo.2011.02.010.
37. Abanador-Kamper N, Bepperling J, Seyfarth M, et al. Impact of left atrial appendage morphology on thrombus formation in TAVI patients with atrial fibrillation. Eur J Med Res. 2023;28(1):88. doi:10.1186/s40001-023-01057-y.
38. Mazur VV, Mazur ES, Bazhenov ND, et al. Epicardial fat and left atrial appendage thrombosis in patients with persistent atrial fibrillation. Obesity and metabolism. 2024;21(1):24-30. (In Russ.) doi:10.14341/omet13030.
39. Khorkova NYu, Gizatulina TP, Belokurova AV, et al. Additional factors of thrombosis of the left atrial appendage in nonvalvular atrial fibrillation. Journal of Arrhythmology. 2020;27(2):26-32. (In Russ.) doi:10.35336/VA-2020-2-26-32.
40. Meng W, Wang L, Fan H, et al. Total Bilirubin Level is Associated with the Risk of Left Atrial Appendage Thrombosis in Patients with Non-Valvular Atrial Fibrillation. Glob Heart. 2022;17(1):90. doi:10.5334/gh.1177.
41. Oshita T, Mine T, Kishima H, et al. Predictors of movable type left atrial appendage thrombi in patients with atrial fibrillation. Heart Vessels. 2020;35(9):1227-33. doi:10.1007/s00380-020-01589-x.
42. Xiong W, Cao Q, Jia L, et al. Machine-learning model for predicting left atrial thrombus in patients with paroxysmal atrial fibrillation. BMC Cardiovasc Disord. 2025;25(1):429. doi:10.1186/s12872-025-04847-w.
43. Joglar JA, Chung MK, Armbruster AL, et al. 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2024;149(1). doi:10.1161/CIR.0000000000001193.
44. Ma C, Wu S, Liu S, et al. Chinese guidelines for the diagnosis and management of atrial fibrillation. Pacing Clin Electrophysiol. 2024;47(6):714-70. doi:10.1111/pace.14920.
45. Mo GL, Wen J, Ye YY, et al. Efficacy and Safety of New Oral Anticoagulants versus Warfarin in the Resolution of Atrial Fibrillation with Left Atrial/Left Atrial Appendage Thrombus: A Systematic Review and Meta-Analysis. Rev Cardiovasc Med. 2025;26(1):26055. doi:10.31083/RCM26055.
46. Ke HH, He Y, Lv XW, et al. Efficacy and safety of rivaroxaban on the resolution of left atrial/left atrial appendage thrombus in nonvalvular atrial fibrillation patients. J Thromb Thrombolysis. 2019;48(2):270-6. doi:10.1007/s11239-019-01876-z.
47. Kushnir A, Bernstein S, Barbhaiya CR, et al. Persistent Left Atrial Appendage Thrombus in Atrial Fibrillation Despite Anticoagulation. J Cardiovasc Electrophysiol. 2025;36(7):1613-8. doi:10.1111/jce.16718.
48. Komlósi F, Arnóth B, Szakál I, et al. Comparative analysis of therapeutic strategies in atrial fibrillation patients with left atrial appendage thrombus despite optimal NOAC therapy. Clin Res Cardiol. 2025. doi:10.1007/s00392-025-02665-w. Epub ahead of print.
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For citations:
Ogurlieva B.B., Naumova L.E., Kuandykova M.V., Zyryanov S.K., Gaidashova O.A. Atrial fibrillation: epidemiology and current issues (a literature review). Russian Journal of Cardiology. 2026;31(3):6872. (In Russ.) https://doi.org/10.15829/1560-4071-2026-6872. EDN: GKHIBW
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