Between 2013 and 2022, the number of newly diagnosed patients with atrial fibrillation (AF) per year steadily increased. The incidence of atrial fibrillation increased from 184 per 100,000 person-years in 2013 to 275 per 100,000 person-years in 2022, reflecting a 1.5-fold increase over the 10 years. [1] 

In Korean adults aged ≥ 20 years, the number of patients with prevalent atrial fibrillation increased from 43,769 in 2013 to 940,063 in 2022, with the prevalence doubling from 1.1 to 2.2% over this time. [1] 

Compared with patients without atrial fibrillation, atrial fibrillation was associated with an increased risk of mortality (hazard ratio [HR]: 1.78; 95% confidence interval [CI] 1.67–1.89) [1] 

In 2022, incidence rate was 301 per 100,000 person-years in men and 249 per 100,000 person-years in women. [1] 

Over these 10 years(2013-2022), the mean age of patients with atrial fibrillation increased gradually from 67.7 to 70.3 years (p-for-trend <0.001). The proportion of the older population aged ≥ 75 years significantly rose from 34.9% in 2017 to 54.9% in 2022. [1] 

The prevalence of atrial fibrillation exhibited slight regional variation, with Jeonbuk reporting the highest prevalence at 3.5% in 2022 and Sejong City reporting the lowest at 1.6%. Comparative analysis between urban and suburban/rural areas revealed a significantly higher prevalence in suburban/rural areas than urban areas (2.4% vs. 1.9%, p < 0.001). [1]

The 2020 European Society of Cardiology (ESC) guidelines introduced the 4S-AF scheme, which encompasses four domains related to atrial fibrillation. Individual patients with atrial fibrillation are assessed based on stroke risk, symptom severity, severity of atrial fibrillation burden, and substrate severity. [2]

From March to July 2014, a total of 1,483 individuals were screened in a Korean community-based study, and 46 were diagnosed with atrial fibrillation. Among them, no symptom was reported in 27 patients (27/46), while dyspnea (10/46), chest discomfort (4/46), palpitation (3/46), edema (3/46), and dizziness/syncope (1/46) were also observed. [3] 

The proportion of the older population aged ≥ 75 years significantly rose from 34.9% in 2017 to 54.9% in 2022. Comorbidities, including hypertension, diabetes, heart failure, prior ischemic stroke, transient ischemic attack, and myocardial infarction, showed a consistent increase throughout the decade; this was accompanied by a rise in the mean CHA2DS2-VASc score from 3.3 points in 2017 to 3.6 points in 2022, along with a gradual increase in the proportion of patients with higher CHA2DS2-VASc scores.  [1]  Among comorbid diseases, hypertension (n=1,757, 50%), ischemic heart disease (n=735, 20.9%) and heart failure (n=519, 14.8%) were related to the incidence of atrial fibrillation. [4] Old age (≥60 years), male sex, and obesity (body mass index [BMI] ≥25 kg/m2) were associated with atrial fibrillation after adjusting for comorbidities. [4]

If atrial fibrillation lasting 30 seconds or longer is confirmed by a physician using a wearable device capable of recording an electrocardiogram (such as a single-lead ECG device), a definitive diagnosis of atrial fibrillation can be made. However, if atrial fibrillation is detected by a method other than ECG (e.g., devices using photoplethysmography) or if the ECG tracing obtained from the device is inconclusive, additional ECG recordings are required to confirm the diagnosis. [5] 

In 2022, 940,063 patients had a prior diagnosis of atrial fibrillation. From 2013 to 2022, the use of antiarrhythmic drugs increased from 12.1 to 16.4% among prevalent atrial fibrillation patients. Beta-blockers (44.6%) were the most commonly prescribed rate control medication, while the use of calcium channel blockers and digoxin declined. The frequency of AF catheter ablation procedures also increased, from 0.5% of prevalent AF patients in 2013 to 0.7% in 2022. Younger patients, males, and those with lower CHA2DS2-VASc scores were more likely to receive AF catheter ablation. [6] 

Compared with patients without AF, AF was associated with an increased risk of ischemic stroke (HR: 2.39; 95% CI 1.98–2.88), major bleeding (HR: 2.10; 95% CI 1.53–2.87), MI (HR: 1.44; 95% CI 1.09–1.91), and HF admission (HR: 2.42; 95% CI 1.88–3.11). [1]  During the study, 20.4% of ischemic strokes were accompanied by AF, with AF diagnosed within 6 months before or after the ischemic stroke. The proportion of patients diagnosed with AF but not received appropriate oral anticoagulant prescriptions until a stroke occurred was 4%. [7] 

A genome-wide association study was conducted with 672 cases (≤60 years old, Yonsei AF Ablation cohort) and 3,700 controls (Korea Genome Epidemiology Study). In this analysis, five previously established genetic loci—1q24/PRRX1, 4q25/PITX2, 10q24/NEURL, 12q24/TBX5, and 16q22/ZFHX3—were successfully validated. Additionally, two novel genetic loci associated with early-onset AF were identified on chromosomes 1q32.1/PPFIA4 (rs11579055, P = 6.84 × 10⁻¹⁰) and 4q34.1/HAND2 (rs8180252, P = 1.49 × 10⁻¹¹). [8] 

[1] Atrial fibrillation fact sheet in Korea 2024 (part 1): epidemiology of atrial fibrillation in Korea. Int J Arrhythm 25, 13 (2024). [2] The 2021 Korean Heart Rhythm Society Guidelines for a New Approach and Integrated Management of Atrial Fibrillation [3] Prevalence of Atrial Fibrillation in the Elderly in Korea, Annals of geriatric medicine and research, 20(1), 29-35. (2016)  [4] Incidence and risk factors for atrial fibrillation in Korea: the national health insurance service database (2002-2010). Korean Circ J. (2016) 46: 515-521 [5] 2021 Korean Heart Rhythm Society Guidelines for Screening and Management of Subclinical Atrial Fibrillation [6] Atrial fibrillation fact sheet in Korea 2024 (part 3): treatment for atrial fibrillation in Korea: medicines and ablation. Int J Arrhythm 25, 15 (2024). [7] Atrial fibrillation fact sheet in Korea 2024: part 2—stroke prevention in Korean patients with atrial fibrillation. Int J Arrhythm 25, 14 (2024). [8] Korean atrial fibrillation network genome-wide association study for early-onset atrial fibrillation identifies novel susceptibility loci. Eur Heart J. 2017 Sep 7;38(34):2586-2594.