New-Onset Atrial Fibrillation as a Predictor of Cancer: Insights from a Real-World Dataset

Ashraf Alzahrani; Kaushik Gokul; Aswathi Paleri; Edward M Powers; Steven Bailin; Eric H Yang; Michael Fradley; Peter Farjo; Paari Dominic

doi:10.1016/j.hrthm.2025.10.040

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New-Onset Atrial Fibrillation as a Predictor of Cancer: Insights from a Real-World Dataset

Journal article

Peer reviewed

New-Onset Atrial Fibrillation as a Predictor of Cancer: Insights from a Real-World Dataset

Ashraf Alzahrani, Kaushik Gokul, Aswathi Paleri, Edward M Powers, Steven Bailin, Eric H Yang, Michael Fradley, Peter Farjo and Paari Dominic

Heart rhythm, Vol.23(4), pp.819-828

04/2026

DOI: 10.1016/j.hrthm.2025.10.040

PMID: 41130552

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Abstract

A bidirectional relationship between atrial fibrillation (AF) and cancer has been suggested, but the mechanisms and directionality remain poorly understood. To examine the relationship between new-onset AF and incident cancer across different age groups. This retrospective study utilized the TriNetX research network. Patients with hypertension, type II diabetes, or coronary artery disease were included and stratified by the presence of AF. Individuals with prior malignancy were excluded. Patients were categorized into three age groups: 30-50, 50-70, and 70-85 years and matched 1:1 using propensity scores. The primary outcome was all-cause cancer incidence, with secondary analyses of site-specific malignancies. Risk ratios, Kaplan-Meier survival analysis, and multivariable Cox regression models were used. Follow-up was up to 15 years after AF diagnosis. Matched cohort sizes were: 30-50 (n=67,156 per group), 50-70 (n=510,308), and 70-85 (n=882,729). AF was associated with increased cancer risk: RR 2.99, 1.79, and 1.49 across increasing age groups (all p<0.001). Kaplan-Meier analyses showed decreased cancer-free survival: HR 2.96, 1.84, and 1.53 across increasing age groups (all p<0.001). Sensitivity analyses excluding cancers diagnosed within the first 3 months and after the first year of AF onset, comparing AF subtypes, and using multivariable Cox models confirmed consistent associations. AF is associated with an increased risk of incident cancer, particularly in younger individuals.

Epidemiology

Cardio-oncology

Atrial fibrillation

Atrial arrhythmia

Cancer

Details

Title: Subtitle: New-Onset Atrial Fibrillation as a Predictor of Cancer: Insights from a Real-World Dataset
Creators: Ashraf Alzahrani - University of Iowa
Kaushik Gokul - Saint Louis University
Aswathi Paleri - University of Iowa, Internal Medicine
Edward M Powers - University of Iowa
Steven Bailin - University of Iowa
Eric H Yang - University of California, Los Angeles
Michael Fradley - University of Pennsylvania
Peter Farjo - University of Iowa
Paari Dominic - University of Iowa Hospitals and Clinics
Resource Type: Journal article
Publication Details: Heart rhythm, Vol.23(4), pp.819-828
DOI: 10.1016/j.hrthm.2025.10.040
PMID: 41130552
NLM abbreviation: Heart Rhythm
ISSN: 1547-5271
eISSN: 1556-3871
Publisher: ELSEVIER SCIENCE INC
Language: English
Electronic publication date: 10/21/2025
Date published: 04/2026
Academic Unit: Cardiovascular Medicine; Internal Medicine
Record Identifier: 9985019148702771

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