Peripheral Artery Disease and Atrial Fibrillation: A Systematic Review and Meta-analysis on 763,919 Patients

Several cardiovascular risk factors and comorbidities have been linked to an increased risk of new-onset atrial fibrillation (NOAF). However, the relationship between peripheral artery disease (PAD) and NOAF has been less extensively investigated.

The purpose of this study was to estimate the risk of NOAF in PAD patients.

We performed a systematic review of MEDLINE (via PubMed) and EMBASE from inception to January 2026 and a meta-analysis of observational studies reporting risk of NOAF in PAD patients. For studies using the ankle-brachial index (ABI), we stratified results according to ABI <1.0 or >1.4.

We included 7 studies with 763,919 patients (56,207 with PAD) and 26,064 NOAF events. The pooled analysis showed an association between PAD and NOAF (HR: 1.34; 95% CI: 1.18-1.50, I² = 85%). PAD defined by low ABI<1.0 was associated with NOAF (HR: 1.18; 95% CI: 1.09-1.28; P < 0.001, I² = 37%) while ABI>1.4 did not reach statistical significance (HR: 1.14; 95% CI: 0.99-1.32; P = 0.07, I² = 33%). PAD defined using International Classification of Diseases-Ninth Revision or clinical history (ie, clinically overt PAD) showed the strongest association with NOAF (HR: 1.40; 95% CI: 1.19-1.66; P < 0.001, I² = 81%). The certainty of the evidence according to GRADE (Grading of Recommendations, Assessment, Development and Evaluations) was low.

Data from observational studies suggest that PAD may be associated with a 34% increased risk of NOAF. In patients diagnosed with PAD (ie, low ABI), proactive management of common atherosclerotic risk factors may be considered to potentially reduce the risk of NOAF.