Skip to main content
PMC home page
Journal of Arrhythmia logoLink to Journal of Arrhythmia
. 2019 Nov 6;35(6):781–788. doi: 10.1002/joa3.12254

Atrial fibrillation risk factor management with a plant‐based diet: A review

Maximilian Andreas Storz 1,✉, Paul Helle 1
PMCID: PMC6898539  PMID: 31844466

Abstract

Atrial fibrillation is the most prevalent cardiac arrhythmia in the clinical setting affecting approximately 34 million individuals worldwide. The disease is associated with a significant burden of morbidity and mortality resulting from stroke, heart failure, and acute coronary syndrome. Atrial fibrillation is now a major public health problem with tremendous implications on the economy and the world's healthcare systems. Numerous risk factors and clinical conditions that are associated with the development and progression of atrial fibrillation have been identified in the past. Within the last decades, a shift in awareness toward modifiable conditions has been observed and risk factor management has gained significant momentum. In light of this, dietary approaches are of paramount importance. Whole‐food plant‐based diets emphasizing grains, legumes, vegetables, fruits and nuts and excluding most (or all) animal products have recently experienced a significantly increased interest. The purpose of this review is to present evidence suggestive of a plant‐based diet being a valuable tool in atrial fibrillation risk factor management. The effects of a plant‐based diet on both established and emerging risk factors, such as inflammation and subclinical atherosclerosis, are reviewed in this article. A special focus is put on cardiovascular and metabolic risk factors including hypertension, coronary artery disease, diabetes, and obesity.

Keywords: atrial fibrillation, lifestyle intervention, plant‐based diet, risk factor, vegan

1. INTRODUCTION

Atrial fibrillation (AF) is the most common arrhythmia in the clinical setting affecting an estimated 2.7 million to 6.1 million Americans and nearly 33.5 million individuals worldwide.1, 2 The disease is recognized as a global public health problem due to its significant burden of mortality and morbidity resulting from stroke, acute coronary syndrome, and heart failure.2, 3 Moreover, AF has vast implications on the economy and public health system. The incremental cost related to AF in the United States is estimated to range from $6.0 to $26.0 billion per year.3, 4 This burden is expected to further increase within the next decades, illustrating, once again, the need for better primary prevention and AF treatment.5, 6

Numerous risk factors, such as hyperthyroidism, diabetes, or hypertension are associated with the disease. Targeting these risk factors and other underlying conditions is an emerging AF management concept that warrants better implementation in daily clinical practice.7

Several of these risk factors are affected by modifiable lifestyle factors, which lead to the idea that certain lifestyle choices, such as diet, may have a tremendous impact on AF risk and mortality. Thus, the purpose of this narrative review is to present selected evidence suggestive of a plant‐based diet being a valuable tool in modifying these risk factors.

2. EPIDEMIOLOGY AND ETIOLOGY

AF burden has significant regional variations, with high‐income countries experiencing a higher prevalence and incidence than low‐ and middle‐income countries.2, 8 The disease currently affects up to 3% of Western populations aged 20 years or older.7 In 2014, Chugh and colleagues compared the prevalence and incidence of AF in Asia and North America.2 The authors reported on significantly lower AF incidence rates in the Asia‐Pacific region compared to North America (33.8 vs 264.5 per 100 000 person‐years for men and 19.8 vs 196.3 per 100 000 person‐years for women respectively). It is noteworthy that a large variation in AF prevalence can be seen between studies and countries.9, 10 Several reviews emphasized a great AF variability existing especially in Asian countries and called for further global epidemiological studies to allow for a more accurate picture of the current AF incidence and prevalence.10 While it is predicted that more than 1 million people in Japan will be affected by the disease by 2050,11 it is now widely accepted that the AF prevalence is generally lower in Asia than in Europe or the United States.

While genetics, natural aging of the population and reporting patterns play an important role, they may not sufficiently explain this unequal distribution. It is more likely that the accumulation of chronic cardiovascular diseases and other risk factors is a major driver of this growing epidemic.7 In this context, a study by Dewland and colleagues revealed that racial differences in AF risk are significantly reduced with the accumulation of cardiovascular comorbidities.12

Multiple risk factors and clinical conditions that are associated with the development and progression of AF have been identified in the last decades.7, 13 Although there are several nonmodifiable risk factors, such as gender or advancing age, a gradual shift in awareness toward modifiable predisposing conditions has been observed.14 Conventional cardiovascular risk factors that are associated with AF include hypertension, coronary heart disease, heart failure (both with reserved and preserved ejection fraction), and valvular heart disease.13, 15 Other well‐established concomitant risk factors include diabetes, overweight, obesity, and hyperthyroidism. Additionally, there is a number of emerging and less well‐researched risk factors, such as subclinical atherosclerosis, inflammation, obstructive sleep apnea, and chronic kidney disease. Finally, there are several dietary components that have been postulated to play a role in the pathogenesis and treatment of AF.16

3. DIET AND ATRIAL FIBRILLATION

Whether dietary factors predispose individuals to AF is partly unexplored and studies from the past often revealed conflicting results.17 At various stages, attention has turned to caffeine, alcohol, fish‐derived long‐chain polyunsaturated fatty acids, and dietary fiber.16, 17

Several prospective studies have described an association between higher levels of alcohol intake and incident AF.7, 14 In fact, acute heavy alcohol consumption and binge drinking have been related to AF long ago.17, 18 An analysis from the Framingham Heart Study revealed a significant association between moderate‐to‐heavy alcohol intake (~ 36 g alcohol/ ≥3 drinks per day) and increased AF risk in men.17, 19 Moreover, Larsson and colleagues described a statistically significant 8% increase in the relative risk of AF with each standard drink per day.20 The precise mechanism by which alcohol intake increases the propensity toward atrial arrhythmias remains unclear.14, 21 Proarrhythmic effects of alcohol intake include shortening of the atrial refractory period,21 diminished vagal and augmented sympathetic heart rate modulation,22 and alteration in atrial current densities.14

The role of caffeine from coffee, tea, and caffeinated soda on AF is less clear.17 Considered a neurohormonal stimulant, caffeine had long been postulated to be proarrhythmic by sympathetic activation.17, 23 Nevertheless, several more recent cohort studies have failed to show this association between caffeine intake and AF.17, 24, 25 On the contrary, a review by Caldeira et al suggested that low‐dose caffeine may even have a protective effect.25

In 2004, the authors of a prospective, population‐based cohort study reported a beneficial association between AF and the intake of fish and fish‐derived polyunsaturated fatty acids.26 Other studies, however, could not confirm these findings.27, 28 Results from the Framingham Heart Study revealed an even increased risk of developing AF in individuals who consumed more than four servings of dark fish per week.17 The authors of this study concluded that their observations may even “suggest a true adverse effect” of fish oil and dark fish on certain subtypes of AF. It has been suggested that methyl mercury and other potential toxins accumulated in fish potentially have a negative effect on cardiac arrhythmia.17

Finally, low serum magnesium levels have been moderately associated with the development of AF in individuals without cardiovascular disease.29, 30 Magnesium administration has been shown to be an effective prophylactic measure for the prevention of postoperative AF.31 Furthermore, intravenous magnesium administration also seems to be effective in the acute management of rapid AF.32 The reservation must be made, however, that another study found no association between dietary magnesium and AF risk.30

In short, there is persuasive evidence that avoidance of certain foods (such as dark fish and alcohol) and intake of specific nutrients (such as magnesium) may beneficially affect AF. This ultimately leads to the question of specific dietary patterns targeting risk factors and concomitant diseases predisposing individuals to AF.

4. RISK FACTOR MODIFICATION THROUGH DIETARY MODIFICATION

The research on dietary patterns and their relation to AF risk is limited to some extent, however, more recently, risk factor management has gained significant momentum.14 Targeting underlying predisposing conditions that are associated with the development and progression of AF seems prudent.7 In this context, nutritional approaches are of paramount importance.

A great example is a recent study by Pathak and colleagues, which revealed that weight loss ≥10% in patients suffering from AF resulted in a sixfold greater probability of arrhythmia‐free survival compared to patients who lost less than 10% of their body weight in the same period.33 The same study also associated sustained weight loss with significant maintenance of sinus rhythm.

Within the last decades, plant‐based nutrition has experienced increased interest in the medical community. Plant‐based diets may reduce the likelihood of many traditional risk factors that are associated with AF, including hypertension, hyperthyroidism, obesity, and diabetes.34 Moreover, plant‐based nutrition may also positively affect emerging risk factors, such as inflammation or subclinical atherosclerosis. Current evidence supporting these statements is present below and in Table 1.

Table 1.

Atrial fibrillation risk factor modification and plant‐based diets: an overview

Risk factors associated with AF Association with a plant‐based diet Suggested mechanisms
Hypertension7, 14, 35 Reduced risk and prevalence of hypertension.38, 39, 41 Improved vasodilation33, 37, 38, increased potassium intake,40, 46 decreased blood viscosity.38, 47
Diabetes7, 14, 48 Improved glycemic control and reduced insulin resistance.51, 55, 56 Low content of advanced glycation endproducts and low saturated fat proportion, decreased lipotoxicity.54, 57, 58
Obesity and obstructive sleep apnea7, 14, 48 Reduced risk and prevalence of obesity, suitable diet for weight loss.59, 60, 61 High fiber and low fat content of plant‐based nutrition. Reduced energy density, increased postprandial energy expenditure60
Systemic Inflammation 13, 70, 71 Reduces mediators of the inflammatory response (hsCRP).77 High in anti‐inflammatory and anti‐oxidative components.40, 73 Absence of pro‐inflammatory fats.43
Coronary Artery Disease7 Prevention and even reversal of atherosclerosis and CAD events.81, 82, 84 Prevention of vascular endothelial cell injury.78, 84 Prevention of LDL oxidation and oxidative inflammation by increased antioxidants.84
Open in a new tab

4.1. Hypertension

Hypertension is one of the major risk factors for AF with reported prevalence rates in AF studies ranging from 49% to 90%.7, 14 Results from the Atherosclerosis Risk in Communities (ARIC) study suggested that hypertension accounted for approximately 22% of incident AF.35 Although there is a strong association between hypertension and AF, an optimal blood pressure target is still subject to debate.14 The LIFE (Losartan Intervention For Endpoint reduction in hypertension) study examined whether lower achieved systolic blood pressure (≤130 mm Hg) was associated with a lower incidence of AF, compared to less‐adequate control (systolic blood pressure ≥142 mm Hg) in hypertensive patients suffering from left ventricular hypertrophy.36, 37 Patients who achieved optimal systolic blood pressure (≤130 mm Hg) had a 40% lower risk of incident AF compared to those with systolic blood pressure ≥142 mm Hg.7, 36 Another trial by Vermond and colleagues revealed, that the risk of incident AF (HR 1.11) increases with every 10 mm Hg increase in systolic blood pressure.15

In light of these findings, it is noteworthy that plant‐based nutrition can lead to a significant decrease in mean blood pressure (BP).38 A meta‐analysis by Yokoyama et al found that consumption of vegetarian diets was associated with lower mean systolic BP (−6.9 mm Hg; 95% CI, −9.1 to −4.7; P < .001) and diastolic BP (−4.7 mm Hg; 95% CI, −6.3 to −3.1; P < .001) in comparison with the consumption of omnivorous diets.39 Moreover, the same meta‐analysis revealed that clinical studies of vegetarian or vegan diets of at least 6 weeks duration lead to a mean decrease of 4.8 mm Hg in systolic BP.39, 40

Plant‐based diets may play an important role not only in the treatment of hypertension but also in its prevention.38 A cross‐sectional analysis of 11 004 British women and men comparing several diet groups (meat eaters, fish eaters, vegetarians, and vegans) found the lowest prevalence of hypertension in the vegan group.41 Mechanisms by which a plant‐based diet may lead to a decrease in BP include improved vasodilation,38, 42, 43 anti‐inflammatory effects, and a greater serum antioxidant capacity,38, 44, 45 increased potassium intake,40, 46 modification of the renin‐angiotensin system, and decreased blood viscosity.38, 47 Reviewing these findings and the association between hypertension and AF, it appears prudent to recommend a plant‐based diet to patients suffering from either condition.

4.2. Diabetes and obesity

Two other major risk factors independently associated with AF include obesity and diabetes.7, 48 Findings from the ARIC study revealed that obesity and overweight (defined as BMI ≥ 25 kg/m2) accounted for approximately 18% of incident AF, while 3% of incident AF was attributable to diabetes.7, 35 Poor glycemic control and longer duration of diabetes are both associated with an increased risk of AF.49 A meta‐analysis by Huxley and colleagues revealed a nearly 40% greater risk of incident AF in individuals suffering from diabetes when compared to unaffected patients.50 In this context, plant‐based nutrition may also play a key role.

Results from the Adventist Health Study‐2 showed that the prevalence of type 2 diabetes (T2D) among individuals consuming vegetarian diets was shown to be approximately half of that in those following an omnivorous dietary pattern.51, 52 In fact, vegetarian dietary patterns have not only been associated with lower prevalence and incidence of diabetes, but also with lower body mass index and lower prevalence of metabolic syndrome and its component factors.53 A meta‐analysis by Yokoyama and colleagues reviewing clinical trials of vegetarian diets in the treatment of T2D found a significant reduction in HbA1c of −0.39 points compared to control diets.51, 54

More recent studies published after the release of this meta‐analysis revealed comparable results. In 2016, Lee et al reported the effects of a brown rice‐based vegan diet on glycemic control in patients suffering from T2D and noted a statistically significant HbA1c reduction of −0.9% in participants with high compliance.55 In 2017, Ramal and colleagues paired a plant‐based diet low in fat and high in fiber with lifestyle support in the treatment of Latinos with T2D who live in medically underserved areas.56 After 6 months, HbA1c levels decreased significantly from 8.53% to 7.31%. Proposed mechanisms by which plant‐based nutrition improves glycemic control and reduces insulin resistance include low content of advanced glycation endproducts, nitrosamines, and a low saturated fat proportion.54, 57, 58 The latter has been shown to significantly contribute to lipotoxicity, a phenomenon in which toxic fat metabolites accumulate in skeletal muscle and hepatic cells, impairing insulin signaling, and thus decreasing glucose uptake.54, 58

In addition to that, plant‐based diets have frequently been linked to healthier weights.59, 60, 61 A review of long‐term studies in vegans and vegetarians has shown a lower prevalence of overweight and obesity compared with nonvegetarians and vegans from a similar background.62, 63 According to Appleby and Key, vegetarians usually have a lower BMI than otherwise comparable nonvegetarians, with differences typically in the range of 1‐2 kg/m2 across all adult age groups.62 Plant‐based diets may not only prevent overweight and obesity, but also promote weight loss.64 These findings are important because incremental increases in BMI have been associated with a significant excess risk of AF in various clinical settings.65 According to a meta‐analysis by Wong and colleagues, every 5 unit increase in BMI was significantly associated with a 10% increase in postoperative AF.14, 65 Then again, weight loss has been associated with an improvement in AF burden and severity in short‐ and long‐term studies.33, 66 In patients suffering from AF, weight loss ≥10% resulted in a sixfold greater probability of arrhythmia‐free survival compared to patients who lost less than 10% of their body weight during the same period.33 The study also revealed a dose‐response effect, with arrhythmia‐free survival rates of 40% with ≤3% weight loss, 66% with 3%‐10% weight loss, and 86% with ≥10% weight loss.33, 67

To achieve and maintain normal weight, adoption of a plant‐based diet might be a useful tool. There is mounting evidence that a plant‐based diet is beneficial in the treatment of T2D and poor metabolic control, which are both established risk factors contributing to an increased risk of AF.54, 68 Thus, a plant‐based diet might be a key component to achieve the treatment goal of a HbA1c value of ≤7% as suggested by the 2016 European Guidelines on cardiovascular disease prevention in clinical practice.69

4.3. Inflammation

Moreover, there is emerging evidence pointing at a close relationship between inflammation and AF.70 Inflammation may contribute to both the occurrence and maintenance of AF and is suggested to be linked to various pathological processes including oxidative stress, altered calcium homeostasis, cardiomyocyte apoptosis, and ultimately fibrosis, which, in turn, promotes AF substrate formation.70, 71, 72 It is particularly noteworthy that the presence of inflammation in the systemic circulation or the heart can predict the onset of AF and its recurrence in the general population.71 Mediators of the inflammatory response can alter atrial electrophysiology and thereby predispose individuals to an increased vulnerability to AF.71

A plant‐based diet is rich in anti‐inflammatory and antioxidative components and has been shown to significantly reduce adverse markers of poor cardiovascular health over time.43, 73, 74 Dietary patterns that are rich in unrefined plant foods have been demonstrated to reduce CRP levels in various studies.40, 75 A study from 2017 found significantly higher CRP levels in omnivores than in vegans (1.1 mg/L vs 0.5 mg/L; P‐level: 0.007).76 Furthermore, a more recent meta‐analysis investigating the association between vegetarian diets and inflammatory biomarkers found that a vegetarian diet might be a useful approach to manage inflammation in the long term.77

Reviewing these findings, the antioxidative and anti‐inflammatory effects of a plant‐based diet might be useful to reduce systemic inflammation, which has been found to contribute to both the occurrence and maintenance of AF.70

4.4. Heart failure and coronary artery disease

Other important risk factors for AF include heart failure and coronary artery disease (CAD).7 Plant‐based diets may beneficially affect both entities and have been shown to be able to halt and even reverse CAD.78, 79, 80 The Lifestyle Heart Trial published by Ornish and colleagues found that more than 80% of patients diagnosed with heart disease who followed a plant‐based diet (lifestyle‐)program had some level of regression of atherosclerosis and 91% had a reduction in the frequency of angina episodes.81 In his book “Prevent and reverse heart disease,” Esselstyn demonstrated that switching patients to a plant‐based diet may result in significant (angiographic) disease reversal.82 A second larger study including almost 200 patients suffering from significant CAD was published in 2014 by the same author.83 About 198 participants were counseled in plant‐based nutrition and asked to consequently eliminate all dairy products, fish, and meat as well as added oils from their daily menu. During the 4 year follow‐up period, 99.4% of the participants who adhered to the whole‐food plant‐based diet avoided any major cardiac event. Angina resolved or improved in almost 93% of participants. A review by Tuso et al identified several mechanisms how a plant‐based diet could prevent CAD events.84 These mechanisms include prevention of vascular endothelial cell injury and prevention of LDL oxidation as well as oxidative inflammation by increased intake of antioxidants.78, 84 Furthermore, prevention of macrophage activation may play an important role.

Heart failure is associated with high rates of morbidity and mortality and, above that, one of the most important risk factors for incident AF.7, 79 There is interventional and observational evidence that a plant‐based diet may decrease the incidence and severity of heart failure.80 More recently, several case reports on plant‐based diets as a potential therapeutic approach in the treatment of heart failure have been published.85, 86 While well‐designed and large randomized, controlled nutrition intervention trials are missing with regard to this entity, a series of potential mechanisms on how a plant‐based diet may beneficially affect heart failure have been postulated.80 These include decreased oxidative stress and inflammation levels, increased nitric oxide bioavailability, reduced homocysteine levels, and increased levels of antioxidants.80, 85

5. DISCUSSION

Atrial fibrillation is the most common arrhythmia and, given its significant burden of morbidity and mortality, a major global public health problem of our time.1, 2 Targeting risk factors and other underlying conditions that predispose individuals to AF is an emerging management concept that warrants better implementation in daily clinical care.7 According to Lau et al, risk factor management is “an essential fourth pillar of AF care” alongside rhythm and rate control as well as appropriate anticoagulation.87 Several independent risk factors, including cardiovascular disease such as hypertension, congestive heart failure, valvular heart disease, coronary artery disease, and obesity and diabetes mellitus have been identified as independent predictors of AF development.7, 14, 87 While the authors of this review believe that it is hard to determine which is the strongest or most important risk factor, it is likely that all these predisposing conditions might complementarily contribute to an increased risk of AF. It is now widely accepted that a high cardiovascular risk profile, which is closely related to a sedentary Western lifestyle, is detrimental and requires sustainable management.

In light of these findings, dietary modifications are of paramount importance. Plant‐based diets may reduce the likelihood of many traditional AF risk factors, including hypertension, coronary artery disease, obesity, and diabetes (see Table 1). Moreover, plant‐based nutrition may also play an important role in modifying emerging AF risk factors, such as inflammation.43, 77

Plant‐based diets emphasize whole grains, legumes, vegetables, fruits, nuts, and seeds while excluding most (or all) animal products. Diets based on whole plant foods not only maximize protective foods, but also exclude potentially harmful animal foods that are high in saturated fat.54 As such, avoiding dark fish and limiting caffeine and alcohol intake might be beneficial in patients suffering from AF. The high magnesium content of a whole‐food plant‐based diet is also noteworthy,88, 89, 90 because low serum magnesium is moderately associated with the development of AF in individuals without cardiovascular disease.29, 30

As postulated by McMacken and Shah, plant‐based diets “address the bigger picture for patients [...]” by simultaneously treating lifestyle diseases (such as diabetes and obesity) and cardiovascular disease.54 In this review, we presented evidence for a plant‐based diet beneficially affecting the most common and important AF risk factors.

Ultimately, the reservation must be made that large and randomized controlled trials specifically investigating the effect of a plant‐based diet on AF are missing. Many clinical and epidemiological studies investigated the effects of a plant‐based diet on risk factors predisposing individuals to AF, however, a large trial specifically tailored to patients suffering from AF is missing. Nevertheless, the current literature points at strong evidence for the beneficial effects of plant‐based diets in cardiovascular disease and its risk factors. Physicians halted and reversed coronary artery disease and even heart failure in severely impaired individuals by prescribing a plant‐based diet. Why would not this be possible in patients suffering from atrial fibrillation?

6. CONCLUSION

Reviewing the current evidence, a whole‐food plant‐based diet might be a valuable tool in managing and reducing common risk factors that are associated with atrial fibrillation, including hypertension, coronary artery disease, inflammation, obesity, and diabetes. Larger randomized controlled trials investigating plant‐based diets in routine AF management are necessary to confirm those findings.

CONFLICT OF INTERESTS

The authors received no specific funding for this work. We hereby confirm, that the manuscript has not been accepted elsewhere for publication. The authors declare that there is no conflict of interest. The authors report no proprietary or commercial interest in any product mentioned or concept discussed in this article.

Storz MA, Helle P. Atrial fibrillation risk factor management with a plant‐based diet: A review. J Arrhythmia. 2019;35:781–788. 10.1002/joa3.12254

REFERENCES

  • 1. Hannibal GB, Copley DJ, Hill KM. Atrial fibrillation: a review of treatments and current guidelines. AACN Adv Crit Care. 2016;27:120–8. 10.4037/aacnacc2016281 [DOI] [PubMed] [Google Scholar]
  • 2. Chugh SS, Havmoeller R, Narayanan K, Singh D, Rienstra M, Benjamin EJ, et al. Worldwide epidemiology of atrial fibrillation. Circulation. 2014;129:837–47. 10.1161/CIRCULATIONAHA.113.005119. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 3. Patel NJ, Atti V, Mitrani RD, Viles‐Gonzalez JF, Goldberger JJ. Global rising trends of atrial fibrillation: a major public health concern. Heart. 2018;104:1989–90. 10.1136/heartjnl-2018-313350 [DOI] [PubMed] [Google Scholar]
  • 4. Kim MH, Johnston SS, Chu B‐C, Dalal MR, Schulman KL. Estimation of total incremental health care costs in patients with atrial fibrillation in the United States. Circ Cardiovasc Qual Outcomes. 2011;4:313–20. 10.1161/CIRCOUTCOMES.110.958165 [DOI] [PubMed] [Google Scholar]
  • 5. Wong CX, Brooks AG, Leong DP, Roberts‐Thomson KC, Sanders P. The increasing burden of atrial fibrillation compared with heart failure and myocardial infarction: a 15‐year study of all hospitalizations in Australia. Arch Intern Med. 2012;172:739–41. 10.1001/archinternmed.2012.878 [DOI] [PubMed] [Google Scholar]
  • 6. Colilla S, Crow A, Petkun W, Singer DE, Simon T, Liu X. Estimates of current and future incidence and prevalence of atrial fibrillation in the U.S. adult population. Am J Cardiol. 2013;112:1142–7. 10.1016/j.amjcard.2013.05.063 [DOI] [PubMed] [Google Scholar]
  • 7. Brandes A, Smit MD, Nguyen BO, Rienstra M, Van Gelder IC. Risk factor management in atrial fibrillation. Arrhythm Electrophysiol Rev. 2018;7:118–27. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 8. Morillo CA, Banerjee A, Perel P, Wood D, Jouven X. Atrial fibrillation: the current epidemic. J Geriatr Cardiol. 2017;14:195–203. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 9. Bai Y, Wang Y‐L, Shantsila A, Lip GYH. The global burden of atrial fibrillation and stroke: a systematic review of the clinical epidemiology of atrial fibrillation in Asia. Chest. 2017;152:810–20. 10.1016/j.chest.2017.03.048 [DOI] [PubMed] [Google Scholar]
  • 10. Zulkifly H, Lip GYH, Lane DA. Epidemiology of atrial fibrillation. Int J Clin Pract. 2018;72:e13070 10.1111/ijcp.13070 [DOI] [PubMed] [Google Scholar]
  • 11. Kodani E, Atarashi H. Prevalence of atrial fibrillation in Asia and the world. J Arrhythm. 2012;28:330–7. 10.1016/j.joa.2012.07.001 [DOI] [Google Scholar]
  • 12. Dewland TA, Olgin JE, Eric V, Marcus GM. Incident atrial fibrillation among asians, hispanics, blacks, and whites. Circulation. 2013;128:2470–7. 10.1161/CIRCULATIONAHA.113.002449 [DOI] [PubMed] [Google Scholar]
  • 13. Wyse DG, Van Gelder IC, Ellinor PT, Go AS, Kalman JM, Narayan SM, et al. Lone atrial fibrillation: does it exist? J Am Coll Cardiol. 2014;63:1715–23. 10.1016/j.jacc.2014.01.023 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 14. Gallagher C, Hendriks JML, Mahajan R, Middeldorp ME, Elliott AD, Pathak RK, et al. Lifestyle management to prevent and treat atrial fibrillation. Expert Rev Cardiovasc Ther. 2016;14:799–809. 10.1080/14779072.2016.1179581 [DOI] [PubMed] [Google Scholar]
  • 15. Vermond RA, Geelhoed B, Verweij N, Tieleman RG, Van der Harst P, Hillege HL, et al. Incidence of atrial fibrillation and relationship with cardiovascular events, heart failure, and mortality: a community‐based study from the Netherlands. J Am Coll Cardiol. 2015;66:1000–7. 10.1016/j.jacc.2015.06.1314 [DOI] [PubMed] [Google Scholar]
  • 16. Nalliah CJ, Sanders P, Kalman JM. The impact of diet and lifestyle on atrial fibrillation. Curr Cardiol Rep. 2018;20:137. [DOI] [PubMed] [Google Scholar]
  • 17. Shen J, Johnson VM, Sullivan LM, Jacques PF, Magnani JW, Lubitz SA, et al. Dietary factors and incident atrial fibrillation: the Framingham Heart Study. Am J Clin Nutr. 2011;93:261–6. 10.3945/ajcn.110.001305 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 18. Ettinger PO, Wu CF, Cruz CDL, Weisse AB, Sultan Ahmed S, Regan TJ. Arrhythmias and the “Holiday Heart”: alcoholassociated cardiac rhythm disorders. Am Heart J. 1978;95:555–62. 10.1016/0002-8703(78)90296-X [DOI] [PubMed] [Google Scholar]
  • 19. Djoussé L, Levy D, Benjamin EJ, Blease SJ, Russ A, Larson MG, et al. Long‐term alcohol consumption and the risk of atrial fibrillation in the Framingham Study. Am J Cardiol. 2004;93:710–3. 10.1016/j.amjcard.2003.12.004 [DOI] [PubMed] [Google Scholar]
  • 20. Larsson SC, Drca N, Wolk A. Alcohol consumption and risk of atrial fibrillation: a prospective study and dose‐response meta‐analysis. J Am Coll Cardiol. 2014;64:281–9. [DOI] [PubMed] [Google Scholar]
  • 21. Marcus GM, Smith LM, Whiteman D, Tseng ZH, Badhwar N, Lee BK, et al. Alcohol intake is significantly associated with atrial flutter in patients under 60 years of age and a shorter right atrial effective refractory period. Pacing Clin Electrophysiol. 2008;31:266–72. 10.1111/j.1540-8159.2008.00985.x [DOI] [PubMed] [Google Scholar]
  • 22. Spaak J, Tomlinson G, McGowan CL, Soleas GJ, Morris BL, Picton P, et al. Dose‐related effects of red wine and alcohol on heart rate variability. Am J Physiol Heart Circ Physiol. 2010;298:H2226–2231. 10.1152/ajpheart.00700.2009 [DOI] [PubMed] [Google Scholar]
  • 23. Bhave PD, Hoffmayer K. Caffeine and atrial fibrillation: friends or foes? Heart. 2013;99:1377–8. [DOI] [PubMed] [Google Scholar]
  • 24. Conen D, Chiuve SE, Everett BM, Zhang SM, Buring JE, Albert CM. Caffeine consumption and incident atrial fibrillation in women. Am J Clin Nutr. 2010;92:509–14. 10.3945/ajcn.2010.29627 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 25. Caldeira D, Martins C, Alves LB, Pereira H, Ferreira JJ, Costa J. Caffeine does not increase the risk of atrial fibrillation: a systematic review and meta‐analysis of observational studies. Heart. 2013;99:1383–9. 10.1136/heartjnl-2013-303950 [DOI] [PubMed] [Google Scholar]
  • 26. Mozaffarian D, Psaty BM, Rimm EB, Lemaitre RN, Burke GL, Lyles MF, et al. Fish intake and risk of incident atrial fibrillation. Circulation. 2004;110:368–73. 10.1161/01.CIR.0000138154.00779.A5 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 27. Brouwer IA, Heeringa J, Geleijnse JM, Zock PL, Witteman JCM. Intake of very long‐chain n‐3 fatty acids from fish and incidence of atrial fibrillation. The Rotterdam Study. Am Heart J. 2006;151:857–62. 10.1016/j.ahj.2005.07.029 [DOI] [PubMed] [Google Scholar]
  • 28. Li F‐R, Chen G‐C, Qin J, Wu X. Dietary fish and long‐chain n‐3 polyunsaturated fatty acids intake and risk of atrial fibrillation: a meta‐analysis. Nutrients. 2017;9(9). 10.3390/nu9090955 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 29. Khan AM, Lubitz SA, Sullivan LM, Sun JX, Levy D, Vasan RS, et al. Low serum magnesium and the development of atrial fibrillation in the community. Circulation. 2013;127:33–8. 10.1161/CIRCULATIONAHA.111.082511 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 30. Misialek JR, Lopez FL, Lutsey PL, Huxley RR, Peacock JM, Chen LY, et al. Serum and dietary magnesium and incidence of atrial fibrillation in whites and in African Americans‐Atherosclerosis Risk in Communities (ARIC) study. Circ J. 2013;77:323–9. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 31. Miller S, Crystal E, Garfinkle M, Lau C, Lashevsky I, Connolly SJ. Effects of magnesium on atrial fibrillation after cardiac surgery: a meta‐analysis. Heart. 2005;91:618–23. 10.1136/hrt.2004.033811 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 32. Onalan O, Crystal E, Daoulah A, Lau C, Crystal A, Lashevsky I. Meta‐analysis of magnesium therapy for the acute management of rapid atrial fibrillation. Am J Cardiol. 2007;99:1726–32. 10.1016/j.amjcard.2007.01.057 [DOI] [PubMed] [Google Scholar]
  • 33. Pathak RK, Middeldorp ME, Meredith M, Mehta AB, Mahajan R, Wong CX, et al. Long‐term effect of goal‐directed weight management in an atrial fibrillation cohort: a long‐term follow‐up study (LEGACY). J Am Coll Cardiol. 2015;65:2159–69. 10.1016/j.jacc.2015.03.002 [DOI] [PubMed] [Google Scholar]
  • 34. Tonstad S, Nathan E, Oda K, Fraser GE. Prevalence of hyperthyroidism according to type of vegetarian diet. Public Health Nutr. 2015;18:1482–7. 10.1017/S1368980014002183 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 35. Huxley RR, Lopez FL, Folsom AR, Agarwal SK, Loehr LR, Soliman EZ, et al. Absolute and attributable risks of atrial fibrillation in relation to optimal and borderline risk factors: the Atherosclerosis Risk in Communities (ARIC) study. Circulation. 2011;123:1501–8. 10.1161/CIRCULATIONAHA.110.009035 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 36. Okin PM, Hille DA, Larstorp ACK, Wachtell K, Kjeldsen SE, Dahlöf B, et al. Effect of lower on‐treatment systolic blood pressure on the risk of atrial fibrillation in hypertensive patients. Hypertension. 2015;66:368–73. 10.1161/HYPERTENSIONAHA.115.05728 [DOI] [PubMed] [Google Scholar]
  • 37. Cuspidi C, Tadic M, Grassi G. How does blood pressure change in hypertensive patients with atrial fibrillation after successful electrical cardioversion? J Clin Hypertens. 2019;21:369–71. 10.1111/jch.13494 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 38. Alexander S, Ostfeld RJ, Allen K, Williams KA. A plant‐based diet and hypertension. J Geriatr Cardiol. 2017;14:327–30. 10.11909/j.issn.1671-5411.2017.05.014 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 39. Yokoyama Y, Nishimura K, Barnard ND, Takegami M, Watanabe M, Sekikawa A, et al. Vegetarian diets and blood pressure: a meta‐analysis. JAMA Intern Med. 2014;174:577–87. 10.1001/jamainternmed.2013.14547 [DOI] [PubMed] [Google Scholar]
  • 40. Campbell T. A plant‐based diet and stroke. J Geriatr Cardiol. 2017;14:321–6. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 41. Appleby PN, Davey GK, Key TJ. Hypertension and blood pressure among meat eaters, fish eaters, vegetarians and vegans in EPIC‐Oxford. Public Health Nutr. 2002;5:645–54. [DOI] [PubMed] [Google Scholar]
  • 42. Vogel RA, Corretti MC, Plotnick GD. Effect of a single high‐fat meal on endothelial function in healthy subjects. Am J Cardiol. 1997;79:350–4. [DOI] [PubMed] [Google Scholar]
  • 43. Barnard N, Goldman D, Loomis J, Kahleova H, Levin S, Neabore S, et al. Plant‐based diets for cardiovascular safety and performance in endurance sports. Nutrients. 2019;11:130 10.3390/nu11010130 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 44. Baradaran A, Nasri H, Rafieian‐Kopaei M. Oxidative stress and hypertension: possibility of hypertension therapy with antioxidants. J Res Med Sci. 2014;19:358–67. [PMC free article] [PubMed] [Google Scholar]
  • 45. Turner‐McGrievy GM, Wirth MD, Shivappa N, Wingard EE, Fayad R, Wilcox S, et al. Randomization to plant‐based dietary approaches leads to larger short‐term improvements in Dietary Inflammatory Index scores and macronutrient intake compared with diets that contain meat. Nutr Res. 2015;35:97–106. 10.1016/j.nutres.2014.11.007 [DOI] [PubMed] [Google Scholar]
  • 46. Bazzano LA, Green T, Harrison TN, Reynolds K. Dietary approaches to prevent hypertension. Curr Hypertens Rep. 2013;15:694–702. 10.1007/s11906-013-0390-z [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 47. McCarty MF. Favorable impact of a vegan diet with exercise on hemorheology: implications for control of diabetic neuropathy. Med Hypotheses. 2002;58:476–86. [DOI] [PubMed] [Google Scholar]
  • 48. Asghar O, Alam U, Hayat SA, Aghamohammadzadeh R, Heagerty AM, Malik RA. Diabetes, obesity and atrial fibrillation: epidemiology, mechanisms and interventions. J Atr Fibrillation. 2013;6:869 10.4022/jafib.869 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 49. Wang A, Green JB, Halperin JL, Piccini JP. Atrial fibrillation and diabetes mellitus: JACC review topic of the week. J Am Coll Cardiol. 2019;74:1107–15. 10.1016/j.jacc.2019.07.020 [DOI] [PubMed] [Google Scholar]
  • 50. Huxley RR, Filion KB, Konety S, Alonso A. Meta‐analysis of cohort and case‐control studies of type 2 diabetes mellitus and risk of atrial fibrillation. Am J Cardiol. 2011;108:56–62. 10.1016/j.amjcard.2011.03.004 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 51. Yokoyama Y, Barnard ND, Levin SM, Watanabe M. Vegetarian diets and glycemic control in diabetes: a systematic review and meta‐analysis. Cardiovasc Diagn Ther. 2014;4:373–82. 10.3978/j.issn.2223-3652.2014.10.04 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 52. Tonstad S, Stewart K, Oda K, Batech M, Herring RP, Fraser GE. Vegetarian diets and incidence of diabetes in the Adventist Health Study‐2. Nutr Metab Cardiovasc Dis. 2013;23:292–9. 10.1016/j.numecd.2011.07.004 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 53. Orlich MJ, Fraser GE. Vegetarian diets in the Adventist Health Study 2: a review of initial published findings. Am J Clin Nutr. 2014;100(Suppl 1):353S–S358. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 54. McMacken M, Shah S. A plant‐based diet for the prevention and treatment of type 2 diabetes. J Geriatr Cardiol. 2017;14:342–54. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 55. Lee Y‐M, Kim S‐A, Lee I‐K, Kim J‐G, Park K‐G, Jeong J‐Y, et al. Effect of a brown rice based vegan diet and conventional diabetic diet on glycemic control of patients with type 2 diabetes: a 12‐week randomized clinical trial. PLoS ONE. 2016;11:e0155918 10.1371/journal.pone.0155918 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 56. Ramal E, Champlin A, Bahjri K. Impact of a plant‐based diet and support on mitigating type 2 diabetes mellitus in latinos living in medically underserved areas. Am J Health Promot. 2018;32:753–62. [DOI] [PubMed] [Google Scholar]
  • 57. Barnard ND, Scialli AR, Turner‐McGrievy G, Lanou AJ, Glass J. The effects of a low‐fat, plant‐based dietary intervention on body weight, metabolism, and insulin sensitivity. Am J Med. 2005;118:991–7. 10.1016/j.amjmed.2005.03.039 [DOI] [PubMed] [Google Scholar]
  • 58. Estadella D, da Penha Ollerdo Nascimento CM, Oyama LM, Ribeiro EB, Dâmaso AR, de Piano A. Lipotoxicity: effects of dietary saturated and transfatty acids. Mediators Inflamm. 2013;2013:137579 10.1155/2013/137579 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 59. Newby PK, Tucker KL, Wolk A. Risk of overweight and obesity among semivegetarian, lactovegetarian, and vegan women. Am J Clin Nutr. 2005;81:1267–74. [DOI] [PubMed] [Google Scholar]
  • 60. Barnard ND, Levin SM, Yokoyama Y. A systematic review and meta‐analysis of changes in body weight in clinical trials of vegetarian diets. J Acad Nutr Diet. 2015;115:954–69. [DOI] [PubMed] [Google Scholar]
  • 61. Tonstad S, Butler T, Yan R, Fraser GE. Type of vegetarian diet, body weight, and prevalence of type 2 diabetes. Diabetes Care. 2009;32:791–6. 10.2337/dc08-1886 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 62. Appleby PN, Key TJ. The long‐term health of vegetarians and vegans. Proc Nutr Soc. 2016;75:287–93. [DOI] [PubMed] [Google Scholar]
  • 63. Harland J, Garton L. An update of the evidence relating to plant‐based diets and cardiovascular disease, type 2 diabetes and overweight. Nutr Bull. 2016;41:323–38. [Google Scholar]
  • 64. Turner‐McGrievy G, Mandes T, Crimarco A. A plant‐based diet for overweight and obesity prevention and treatment. J Geriatr Cardiol. 2017;14:369–74. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 65. Wong CX, Sullivan T, Sun MT, Mahajan R, Pathak RK, Middeldorp M, et al. Obesity and the risk of incident, post‐operative, and post‐ablation atrial fibrillation: a meta‐analysis of 626,603 individuals in 51 studies. JACC: Clin Electrophysiol. 2015;1:139–52. 10.1016/j.jacep.2015.04.004 [DOI] [PubMed] [Google Scholar]
  • 66. Abed HS, Wittert GA, Leong DP, Shirazi MG, Bahrami B, Middeldorp ME, et al. Effect of weight reduction and cardiometabolic risk factor management on symptom burden and severity in patients with atrial fibrillation: a randomized clinical trial. JAMA. 2013;310:2050–60. 10.1001/jama.2013.280521 [DOI] [PubMed] [Google Scholar]
  • 67. Laplante L, Allard C, Rivard L, Khairy P. Weighing the evidence for weight loss as a therapeutic strategy for atrial fibrillation. Expert Rev Cardiovasc Ther. 2016;14:877–9. 10.1080/14779072.2016.1199274 [DOI] [PubMed] [Google Scholar]
  • 68. Toumpanakis A, Turnbull T, Alba‐Barba I. Effectiveness of plant‐based diets in promoting well‐being in the management of type 2 diabetes: a systematic review. BMJ Open Diabetes Res Care. 2018;6:e000534. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 69. Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL, et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts)Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J. 2016;37:2315–81. 10.1093/eurheartj/ehw106 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 70. Harada M, Van Wagoner DR, Nattel S. Role of inflammation in atrial fibrillation pathophysiology and management. Circ J. 2015;79:495–502. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 71. Hu Y‐F, Chen Y‐J, Lin Y‐J, Chen S‐A. Inflammation and the pathogenesis of atrial fibrillation. Nat Rev Cardiol. 2015;12:230–43. 10.1038/nrcardio.2015.2 [DOI] [PubMed] [Google Scholar]
  • 72. Boos CJ, Anderson RA, Lip GYH. Is atrial fibrillation an inflammatory disorder? Eur Heart J. 2006;27:136–49. [DOI] [PubMed] [Google Scholar]
  • 73. Kahleova H, Matoulek M, Malinska H, Oliyarnik O, Kazdova L, Neskudla T, et al. Vegetarian diet improves insulin resistance and oxidative stress markers more than conventional diet in subjects with Type 2 diabetes. Diabet Med. 2011;28:549–59. 10.1111/j.1464-5491.2010.03209.x [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 74. Shah B, Newman JD, Woolf K, Ganguzza L, Guo YU, Allen N, et al. Anti‐inflammatory effects of a vegan diet versus the american heart association‐recommended diet in coronary artery disease trial. J Am Heart Assoc. 2018;7(23). 10.1161/JAHA.118.011367 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 75. Craddock JC, Neale EP, Peoples GE, Probst YC. Vegetarian‐based dietary patterns and their relation with inflammatory and immune biomarkers: a systematic review and meta‐analysis. Adv Nutr. 2019;10:433–51. 10.1093/advances/nmy103 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 76. Franco‐de‐Moraes AC, de Almeida‐Pititto B, da Rocha Fernandes G, Gomes EP, da Costa Pereira A, Ferreira SRG. Worse inflammatory profile in omnivores than in vegetarians associates with the gut microbiota composition. Diabetol Metab Syndr. 2017;9: 10.1186/s13098-017-0261-x [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 77. Haghighatdoost F, Bellissimo N, Totosy de Zepetnek JO, Rouhani MH. Totosy de Zepetnek JO, Rouhani MH. Association of vegetarian diet with inflammatory biomarkers: a systematic review and meta‐analysis of observational studies. Public Health Nutr. 2017;20:2713–21. 10.1017/S1368980017001768 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 78. Esselstyn CB. A plant‐based diet and coronary artery disease: a mandate for effective therapy. J Geriatr Cardiol. 2017;14:317–20. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 79. Choi EY, Allen K, McDonnough M, Massera D, Ostfeld RJ. A plant‐based diet and heart failure: case report and literature review. J Geriatr Cardiol. 2017;14:375–8. 10.11909/j.issn.1671-5411.2017.05.003 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 80. Kerley CP. A review of plant‐based diets to prevent and treat heart failure. Card Fail Rev. 2018;4:54–61. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 81. Ornish D, Scherwitz LW, Billings JH, Brown SE, Gould KL, Merritt TA, et al. Intensive lifestyle changes for reversal of coronary heart disease. JAMA. 1998;280:2001–7. 10.1001/jama.280.23.2001 [DOI] [PubMed] [Google Scholar]
  • 82. Esselstyn CB Jr. Prevent and reverse heart disease. Prog Clin Biol Res. 2007;1:347–355. [Google Scholar]
  • 83. Esselstyn CB, Gendy G, Doyle J, Golubic M, Roizen MF. A way to reverse CAD? J Fam Pract. 2014;63:356–364b. [PubMed] [Google Scholar]
  • 84. Tuso P, Stoll SR, Li WW. A plant‐based diet, atherogenesis, and coronary artery disease prevention. Perm J. 2015;19:62–7. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 85. Allen KE, Gumber D, Heart ORJ. Failure and a plant‐based diet. a case‐report and literature review. Front Nutr. 2019;6 10.3389/fnut.2019.00082 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 86. Najjar RS, Montgomery BD. A defined, plant‐based diet as a potential therapeutic approach in the treatment of heart failure: a clinical case series. Complement Ther Med. 2019;45:211–4. [DOI] [PubMed] [Google Scholar]
  • 87. Lau DH, Stanley N, Kalman Jonathan M, Prashanthan S. Modifiable risk factors and atrial fibrillation. Circulation. 2017;136:583–96. 10.1161/CIRCULATIONAHA.116.023163 [DOI] [PubMed] [Google Scholar]
  • 88. Koebnick C, Leitzmann R, García AL, Heins UA, Heuer T, Golf S, et al. Long‐term effect of a plant‐based diet on magnesium status during pregnancy. Eur J Clin Nutr. 2005;59:219–25. 10.1038/sj.ejcn.1602062 [DOI] [PubMed] [Google Scholar]
  • 89. Kristensen NB, Madsen ML, Hansen TH, Allin KH, Hoppe C, Fagt S, et al. Intake of macro‐ and micronutrients in Danish vegans. Nutr J. 2015;14(1). 10.1186/s12937-015-0103-3 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 90. Craig WJ. Health effects of vegan diets. Am J Clin Nutr. 2009;89:1627S–1633S. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Arrhythmia are provided here courtesy of Japanese Heart Rhythm Society

RESOURCES