The year in cardiovascular medicine 2021: arrhythmias

GRAPHICAL ABSTRACT Randomized trials reported on food supplements to prevent atrial fibrillation (AF) (1), screening for AF (22), and left atrial appendage occlusion (41) to prevent stroke and novel pacing strategies to prevent death in heart failure patients (33) or syncope recurrence (35). In RATE-AF, digoxin was superior to bisoprolol (27), illustrating an old drug can be effective if wisely applied with a patient-oriented endpoint. To improve the impact of primary prevention ICD, the MADIT-ICD benefit score balances the risk of sudden cardiac death and the competing risk of non-arrhythmic death (50) (calculator at https://redcap.urmc.rochester.edu/redcap/ surveys/index.php?s=3H888TJ8N7). The worldwide differences in ICD usage (56) further support a unified approach focusing on ICD benefits. Contrary to current guidelines, the EAST-AFNET4 substudy suggests that (early) rhythm control benefits asymptomatic and symptomatic patients alike concerning cardiovascular endpoints (57). Alcohol does not protect from AF no matter dose or type of alcohol (Csengeri study) (3), although the latter is at variance with another recent BIOBANK study (7). Stopping consuming alcohol after detection of AF may reduce stroke (5); it may also reduce the recurrence of AF after ablation (6). Less AF (24, 25) and stroke (25) was also seen with higher levels of physical activity (PA) as measured by modern day monitoring technology (#) in LOOP trial (24) and UK Biobank (25). Also from the UK Biobank: long-term night shift work may cause AF (8).