The association between atrial fibrillation (AF) and nonsteroidal anti-inflammatory drug (NSAID) use demonstrated by De Caterina et al1 may be augmented by at least 2 common mechanisms not included among those that they proposed. Reflux esophagitis is extremely common during NSAID use and has been independently associated with AF2; its treatment with protein pump inhibitors (PPIs) has been associated with less frequent AF.3,4 Prolonged, habitual, physical effort, which may increase NSAID use, may also induce a much greater frequency of AF,5 potentially contributing to the NSAID-AF association.
Daniell HW. Gastroesophageal Reflux Disease Stimulation of NSAID-Associated Atrial Fibrillation. Arch Intern Med. 2011;171(7):702-710. doi:10.1001/archinternmed.2011.107