There have been several anecdotal examples of atrial fibrillation associated with chronic pain.
The REGARDS study followed 30,239 patients over 4 years. The prevalence of AF was higher in opioid users than nonusers (12.5% vs 7.6%). The postulated mechanism is : Endogenous opioid peptides open mitochondrial potassium ATP channels, making mitochondria resistant to oxidative stress. Loss of this protective mechanism against oxidative stress may render atrial myocytes amenable to damage, leading to AF
Anxiety and depression related to chronic pain may contribute to AFIB.