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Int J Cardiol. 2013 Oct 15;168(6):5411-5. doi: 10.1016/j.ijcard.2013.08.048. Epub 2013 Aug 24.

Serum potassium levels and the risk of atrial fibrillation: the Rotterdam Study.

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Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands; Netherlands Consortium for Healthy Aging (NCHA), The Netherlands.



Atrial fibrillation is the most common sustained arrhythmia in the elderly. Serum potassium is associated with ventricular arrhythmias and cardiac arrest. Little is known about the association of serum potassium with atrial fibrillation. The objective of this study was to investigate the association of serum potassium and the risk of atrial fibrillation in a population based setting.


The study was performed within the prospective population-based Rotterdam Study. The study population consisted of 4059 participants without atrial fibrillation at baseline for whom baseline levels of serum potassium were measured. Atrial fibrillation was ascertained from centre visit ECG assessments as well as medical records.


During a mean follow up of 11.8 years (SD=5.2 yr), 474 participants developed atrial fibrillation. Participants with hypokalemia (<3.5 mmol/l) had a higher risk of atrial fibrillation (HR: 1.63, 95%CI: 1.03-2.56) than those with normokalemia (3.5-5.0 mmol/l). This association was independent of age, sex, serum magnesium, and other potential confounders. Especially in participants with a history of myocardial infarction, those with hypokalemia had a higher risk of atrial fibrillation than those with normokalemia (HR: 3.81, 95%-CI: 1.51-9.61).


In this study low serum levels of potassium were associated with a higher risk of atrial fibrillation.


Atrial fibrillation; Epidemiology; Serum potassium

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