Lone atrial fibrillation (LAF) is generally regarded as a benign disorder that does not significantly increase the risk of thromboembolism
and mortality. However, there is growing evidence that “lone” atrial fibrillation (AF) is a “heterogeneous” disorder with
varying risk for thromboembolism based on the patient’s underlying cardiovascular risk factors. Blood biomarkers, including markers of
myocardial strain, inflammation, endothelial injury, platelet activation, and hypercoagulability, have potential to improve our risk
stratification and management of LAF.
Currently, there is a paucity of data on biomarkers in strictly defined LAF. The majority of studies that aimed to study lone atrial
fibrillation excluded patients with structural heart disease, but did not exclude patients with co-existing cardiovascular risk factors such as
hypertension or diabetes mellitus. Moreover, many of the studies did not exclude patients based on age, thereby increasing the likelihood
of including patients with cardiovascular co-morbidities. There are currently a limited number of studies aimed to investigate the role of
biomarkers in true LAF. The results are conflicting as to whether these biomarkers are associated with LAF or stroke risk. Future studies
enrolling patients with true LAF using strict definition are needed. Herein, we review our current knowledge of biomarkers in association
with atrial fibrillation and LAF and discuss their potential clinical utility.