{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T07:15:54Z","timestamp":1791875754407,"version":"4.3.4"},"reference-count":114,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2022,12,26]],"date-time":"2022-12-26T00:00:00Z","timestamp":1672012800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["MOP142426"],"award-info":[{"award-number":["MOP142426"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007206","name":"Vanderbilt Institute for Clinical and Translational Research","doi-asserted-by":"publisher","award":["UL1\u2010TR000445"],"award-info":[{"award-number":["UL1\u2010TR000445"]}],"id":[{"id":"10.13039\/100007206","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Aliment Pharmacol Ther"],"published-print":{"date-parts":[[2023,2]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Atrial fibrillation (AF) is the most common arrhythmia and its management in cirrhosis can be challenging due to the altered hepatic metabolism of medications and increased risk of bleeding.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>To provide a comprehensive overview of the diagnosis, pathophysiology and management of AF in patients with cirrhosis from both a cardiology and a hepatology perspective.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>An extensive literature search was performed using the terms \u2018atrial fibrillation\u2019 and \u2018cirrhosis\u2019. Guideline documents and consensus statements were explored.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The prevalence of AF in patients with cirrhosis ranges between 6.6% and 14.2%, while the incidence of new\u2010onset AF in the post\u2010operative period after liver transplant ranged between 6.8% and 10.2%. AF in patients with cirrhosis is associated with adverse outcomes in both pre\u2010transplant and post\u2010transplant settings, including an increased risk of stroke when compared to the general population. We review the pathogenesis of AF in general and in cirrhosis. This review also provides guidance on the management of AF, including the use of anticoagulation and rate versus rhythm control. In the absence of strict contraindications, all patients with cirrhosis and AF should be anticoagulated. The use of DOACs is preferred over vitamin K antagonists. In patients with a high bleeding risk, a DOAC with an approved antidote may be preferred.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Atrial fibrillation is increased in patients with cirrhosis. AF management requires careful consideration of treatment options. Since patients with cirrhosis were excluded from all major randomised clinical trials, dedicated research on the pathophysiology and management of AF in cirrhosis is needed.<\/jats:p><\/jats:sec>","DOI":"10.1111\/apt.17368","type":"journal-article","created":{"date-parts":[[2022,12,26]],"date-time":"2022-12-26T20:03:05Z","timestamp":1672084985000},"page":"290-303","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Review article: diagnosis, pathophysiology and management of atrial fibrillation in cirrhosis and portal hypertension"],"prefix":"10.1111","volume":"57","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8296-920X","authenticated-orcid":false,"given":"Bert","family":"Vandenberk","sequence":"first","affiliation":[{"name":"Department of Cardiac Sciences Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary  Calgary Alberta Canada"},{"name":"Department of Cardiovascular Sciences KU Leuven  Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4164-1771","authenticated-orcid":false,"given":"Mario H.","family":"Altieri","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Hepatology and Nutrition CHU Caen  Caen France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6805-5177","authenticated-orcid":false,"given":"Hongqun","family":"Liu","sequence":"additional","affiliation":[{"name":"Liver Unit Cumming School of Medicine, University of Calgary  Calgary Alberta Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5890-3785","authenticated-orcid":false,"given":"Satish R.","family":"Raj","sequence":"additional","affiliation":[{"name":"Department of Cardiac Sciences Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary  Calgary Alberta Canada"},{"name":"Autonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Medicine Vanderbilt University Medical Center  Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4431-272X","authenticated-orcid":false,"given":"Samuel S.","family":"Lee","sequence":"additional","affiliation":[{"name":"Liver Unit Cumming School of Medicine, University of Calgary  Calgary Alberta Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,12,26]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.3389\/fnetp.2022.849253"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.5009\/gnl210537"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehaa612"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.4103\/0975-3583.95363"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/liv.14291"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/liv.13459"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.118.008703"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.dld.2021.11.011"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.113.005119"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(15)70027-X"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjca.2020.09.001"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.92.7.1954"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2016.11.003"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.111.019893"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.113.006641"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2014.06.1172"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2018.10.020"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.2174\/0929867324666170727103357"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2013.06.141"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199809033391003"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1097\/HCO.0b013e3283413925"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhepr.2021.100316"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/apt.16305"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.30875"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10554-020-01920-7"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0168-8278(97)80458-8"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0041-1345(03)00587-6"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.4254\/wjh.v7.i4.662"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0168-8278(98)80022-6"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2009.12.075"},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0035-1564794"},{"key":"e_1_2_11_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cld.2019.06.002"},{"key":"e_1_2_11_34_1","doi-asserted-by":"publisher","DOI":"10.14309\/ajg.0000000000000786"},{"key":"e_1_2_11_35_1","doi-asserted-by":"publisher","DOI":"10.1111\/liv.14037"},{"key":"e_1_2_11_36_1","doi-asserted-by":"publisher","DOI":"10.1155\/2014\/509204"},{"key":"e_1_2_11_37_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.110.957100"},{"key":"e_1_2_11_38_1","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euw373"},{"key":"e_1_2_11_39_1","doi-asserted-by":"publisher","DOI":"10.3390\/toxins12040227"},{"issue":"1","key":"e_1_2_11_40_1","first-page":"448","article-title":"Chronic kidney disease and atrial fibrillation: a contemporary overview","volume":"5","author":"Kulkarni N","year":"2012","journal-title":"J Atr Fibrillation"},{"key":"e_1_2_11_41_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cld.2021.01.012"},{"key":"e_1_2_11_42_1","doi-asserted-by":"publisher","DOI":"10.17219\/acem\/28681"},{"key":"e_1_2_11_43_1","doi-asserted-by":"publisher","DOI":"10.1053\/gast.2001.28653"},{"issue":"2","key":"e_1_2_11_44_1","first-page":"G537","article-title":"Potassium currents in atrial and ventricular myocytes from a rat model of cirrhosis","volume":"273","author":"Ward CA","year":"1997","journal-title":"Am J Physiol"},{"key":"e_1_2_11_45_1","doi-asserted-by":"publisher","DOI":"10.3389\/fphys.2021.719883"},{"key":"e_1_2_11_46_1","doi-asserted-by":"publisher","DOI":"10.1177\/1756284819832237"},{"key":"e_1_2_11_47_1","doi-asserted-by":"publisher","DOI":"10.1080\/17474124.2019.1587293"},{"key":"e_1_2_11_48_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.28740"},{"key":"e_1_2_11_49_1","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfac282"},{"issue":"4","key":"e_1_2_11_50_1","first-page":"204","article-title":"Spontaneous bacterial peritonitis: a review of treatment options","volume":"34","author":"Alaniz C","year":"2009","journal-title":"P T"},{"key":"e_1_2_11_51_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-1253(19)30349-8"},{"key":"e_1_2_11_52_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2016.08.074"},{"key":"e_1_2_11_53_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-8703(78)90296-X"},{"key":"e_1_2_11_54_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehaa953"},{"key":"e_1_2_11_55_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2014.03.048"},{"key":"e_1_2_11_56_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1817591"},{"key":"e_1_2_11_57_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2021.11.007"},{"key":"e_1_2_11_58_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cld.2022.03.004"},{"key":"e_1_2_11_59_1","doi-asserted-by":"publisher","DOI":"10.2459\/JCM.0000000000001369"},{"key":"e_1_2_11_60_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.110.960401"},{"key":"e_1_2_11_61_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.29329"},{"key":"e_1_2_11_62_1","doi-asserted-by":"publisher","DOI":"10.31083\/j.rcm2303091"},{"key":"e_1_2_11_63_1","doi-asserted-by":"publisher","DOI":"10.4330\/wjc.v12.i7.342"},{"key":"e_1_2_11_64_1","doi-asserted-by":"publisher","DOI":"10.4022\/jafib.2248"},{"key":"e_1_2_11_65_1","doi-asserted-by":"publisher","DOI":"10.21037\/atm-21-3111"},{"key":"e_1_2_11_66_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2022.05.030"},{"key":"e_1_2_11_67_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.13034"},{"key":"e_1_2_11_68_1","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.120.031454"},{"key":"e_1_2_11_69_1","doi-asserted-by":"publisher","DOI":"10.1002\/lt.25631"},{"key":"e_1_2_11_70_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.transproceed.2018.01.039"},{"key":"e_1_2_11_71_1","doi-asserted-by":"publisher","DOI":"10.4254\/wjh.v10.i10.761"},{"key":"e_1_2_11_72_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1011170"},{"key":"e_1_2_11_73_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2021.11.004"},{"key":"e_1_2_11_74_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2021.09.003"},{"key":"e_1_2_11_75_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2022.02.022"},{"key":"e_1_2_11_76_1","doi-asserted-by":"publisher","DOI":"10.1002\/rth2.12668"},{"key":"e_1_2_11_77_1","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.121.024868"},{"key":"e_1_2_11_78_1","doi-asserted-by":"publisher","DOI":"10.1160\/TH16-06-0450"},{"key":"e_1_2_11_79_1","doi-asserted-by":"publisher","DOI":"10.1160\/TH17-07-0478"},{"key":"e_1_2_11_80_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10840-014-9930-y"},{"key":"e_1_2_11_81_1","doi-asserted-by":"publisher","DOI":"10.1111\/jth.14692"},{"key":"e_1_2_11_82_1","doi-asserted-by":"publisher","DOI":"10.1111\/jth.15789"},{"key":"e_1_2_11_83_1","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.116.005307"},{"key":"e_1_2_11_84_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.dld.2018.12.001"},{"key":"e_1_2_11_85_1","doi-asserted-by":"publisher","DOI":"10.1111\/eci.13397"},{"key":"e_1_2_11_86_1","doi-asserted-by":"publisher","DOI":"10.1182\/bloodadvances.2019000885"},{"key":"e_1_2_11_87_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11239-019-01973-z"},{"key":"e_1_2_11_88_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2022.04.009"},{"key":"e_1_2_11_89_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2011.06.055"},{"key":"e_1_2_11_90_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2016-311696"},{"key":"e_1_2_11_91_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2013-306502"},{"key":"e_1_2_11_92_1","doi-asserted-by":"publisher","DOI":"10.3350\/cmh.2020.0234"},{"key":"e_1_2_11_93_1","first-page":"CD011510","article-title":"Carvedilol versus traditional, non\u2010selective beta\u2010blockers for adults with cirrhosis and gastroesophageal varices","volume":"10","author":"Zacharias AP","year":"2018","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_11_94_1","doi-asserted-by":"publisher","DOI":"10.1111\/apt.12324"},{"key":"e_1_2_11_95_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2015-010902"},{"key":"e_1_2_11_96_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2014.03.060"},{"key":"e_1_2_11_97_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ccep.2018.05.016"},{"key":"e_1_2_11_98_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra2021808"},{"key":"e_1_2_11_99_1","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.122.025600"},{"key":"e_1_2_11_100_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2017.03.019"},{"key":"e_1_2_11_101_1","doi-asserted-by":"publisher","DOI":"10.1111\/jce.14671"},{"key":"e_1_2_11_102_1","doi-asserted-by":"publisher","DOI":"10.1111\/pace.13752"},{"key":"e_1_2_11_103_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.121.056323"},{"key":"e_1_2_11_104_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2029980"},{"key":"e_1_2_11_105_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2019422"},{"key":"e_1_2_11_106_1","doi-asserted-by":"publisher","DOI":"10.1111\/pace.14341"},{"key":"e_1_2_11_107_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(02)11315-8"},{"key":"e_1_2_11_108_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11096-016-0414-2"},{"key":"e_1_2_11_109_1","doi-asserted-by":"publisher","DOI":"10.1152\/ajpgi.00458.2020"},{"key":"e_1_2_11_110_1","doi-asserted-by":"publisher","DOI":"10.2174\/157016108784912019"},{"issue":"1","key":"e_1_2_11_111_1","first-page":"11","article-title":"How toxic is amiodarone to the liver?","volume":"19","author":"Pollak PT","year":"2010","journal-title":"J Gastrointestin Liver Dis"},{"key":"e_1_2_11_112_1","first-page":"31","volume-title":"Cardio\u2010hepatology: connections between hepatic and cardiovascular disease","author":"Pollak PT","year":"2022"},{"key":"e_1_2_11_113_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.121.010321"},{"key":"e_1_2_11_114_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2019.11.004"},{"key":"e_1_2_11_115_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1408288"}],"container-title":["Alimentary Pharmacology &amp; Therapeutics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/apt.17368","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/apt.17368","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/apt.17368","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,19]],"date-time":"2023-08-19T13:20:46Z","timestamp":1692451246000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/apt.17368"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12,26]]},"references-count":114,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2023,2]]}},"alternative-id":["10.1111\/apt.17368"],"URL":"https:\/\/doi.org\/10.1111\/apt.17368","archive":["Portico"],"relation":{},"ISSN":["0269-2813","1365-2036"],"issn-type":[{"value":"0269-2813","type":"print"},{"value":"1365-2036","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,12,26]]},"assertion":[{"value":"2022-09-19","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-12-08","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-12-26","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}