Patterns and trends in atrial fibrillation and atrial flutter incidence rates in G20 countries (1990–2021) and predictions to 2050

The long-term trend in atrial fibrillation (AF) and atrial flutter (AFL) incidence has rarely been reported from a global perspective. We aimed to explore the past temporal trends (1990–2021) in AF/AFL incidence in group of 20 countries and to predict future trends (2022–2050). Data on yearly AF/AFL incidence by age group and sex were extracted from the global burden of disease study 2021. Age-standardized incidence rates (ASIR) were computed from 1990 to 2021. The number of new cases and incidence rates were predicted to 2050 using the Bayesian age–period–cohort model. The ASIR for AF/AFL exhibited a slight increasing trend on a global scale from 1990 to 2021, with an average annual percent change of 0.5% (95% confidence interval: 0.5–0.5). Canada had the highest ASIR of AF/AFL (97.53/100,000) and showed a significant declining trend from 1990 to 2021, while the USA and Germany showed a clear upward trend and a “wave-like” upward trend, respectively. Notably, Italy experienced a significant increase in the ASIR of AF/AFL during the COVID-19 pandemic (2019–2021), with an annual percent change of 9.3% (95% confidence interval: 6.6–12.0). The ASIR of AF/AFL in developing countries increased more significantly than in developed countries (ASIR change percentage: 4.79% vs 0.20%). The ASIR of AF/AFL is predicted to remain stable or increase in most countries by 2050. AF/AFL remains a significant public health concern, necessitating the development of more precise strategies for prevention, control, and surveillance, particularly among specific populations and endemic countries.