Drug-induced atrial fibrillation: does it matter?

Atrial fibrillation (AF) is a major cause of hospitalization, morbidity, and mortality. Clinical reports indicate that an increasing number of cardiovascular (adenosine, positive inotropics) and non-cardiovascular (cancer chemotherapy, non-steroidal anti-inflammatory agents, high-dose methylprednisolone, and several respiratory medications) drugs can induce AF, increasing the number of hospitalizations. The risk of drug-induced AF (DIAF) would be expected to increase in the elderly, as they present a high incidence of AF and are treated with multiple drugs, and in patients with comorbidities frequently associated with AF. However, because of its short duration and the physicians are not aware about this side-effect, DIAF has received little attention when patients present a new-onset AF and epidemiologic studies to quantify the relation between certain drugs and AF have not yet been performed. Thus, further research is needed to obtain more insight into DIAF, to determine the incidence and risk factors, and whether it can increase the risk of thromboembolism or mortality. Meanwhile, when a patient presents a new-onset AF, it is recommended to review his/her medical and pharmacological history to identify whether any of the prescribed drugs may be responsible for the episode.