COVID‑19 Vaccination Recommendations for Patients with Paroxysmal Atrial Fibrillation

Primary Recommendation

The American College of Cardiology recommends that patients with paroxysmal atrial fibrillation receive COVID‑19 vaccination because the benefits substantially outweigh the risks, and COVID‑19 infection poses a markedly higher thromboembolic risk than vaccination. 1
According to the American College of Cardiology, COVID‑19 vaccination shows a very favorable benefit‑to‑risk profile across all evaluated age and sex groups, including individuals with cardiovascular disease. 3

Patients with pre‑existing atrial fibrillation should continue their oral anticoagulant therapy when receiving a COVID‑19 vaccine. (Chest) 4
All cardiac medications—including anticoagulants, rate‑control agents, and antiarrhythmics—should be maintained without interruption during vaccination. (Chest) 4
Discontinuing anticoagulation for vaccination increases thrombotic risk without benefit and should be avoided. (Chest) 4

The American College of Cardiology notes that atrial fibrillation is associated with elevated ACE2 expression, potentially increasing susceptibility to severe COVID‑19 outcomes. 5
Patients with suboptimally controlled heart‑rhythm disorders have a higher risk of disease exacerbation if they contract COVID‑19. (American College of Cardiology) 5

Either mRNA COVID‑19 vaccine may be used in patients with paroxysmal atrial fibrillation, with no preference between products. (Arthritis & Rheumatology) 6
Routine post‑vaccination antibody testing to assess immunity is not indicated. (Arthritis & Rheumatology) 7

Vaccination should not be withheld due to concerns about arrhythmia risk; properly anticoagulated patients show minimal to no increase in arrhythmic events. (Chest) 4
Vaccination should not be delayed in stable paroxysmal atrial fibrillation patients, unless they are experiencing a life‑threatening illness requiring intensive care. (Arthritis & Rheumatology) 6