Abstract Body (Do not enter title and authors here): Background:
Carbon monoxide (CO) poisoning is a significant public health threat, with emerging attention on its cardiovascular consequences such as myocardial injury, heart failure, and arrhythmias. Notably, atrial fibrillation (AF) has been sporadically reported, suggesting a potential link between CO exposure and cardiac dysrhythmias.

Case Report:
A 72-year-old female with hypothyroidism and IBS presented to the emergency department with sudden gait imbalance, dizziness, and an occipital headache. Her ECG showed new-onset atrial fibrillation, with subsequent unremarkable echocardiography and brain imaging. Remarkably, her husband exhibited similar symptoms and both had recently been camping. Suspecting CO poisoning, carboxyhemoglobin was tested and found to be 2.9%, with no methemoglobinemia. The patient spontaneously converted to normal sinus rhythm during hospitalization and maintained it during hospitalization without hyperbaric oxygen therapy.

Systematic Review of Case Reports: We identified seven cases of carbon monoxide-induced atrial fibrillation from 45 citations. Patients were mostly male (57.14%), aged 21 to 82, and presented with diverse symptoms, primarily headache (57.1%) and nausea (57.1%). Rapid ventricular response occurred in 85.7% of cases, none with a prior history of atrial fibrillation. Most (85.7%) returned to normal sinus rhythm upon discharge, and 71.4% maintained it on follow-up. Normobaric oxygen therapy was given in 57.1% of cases, and hyperbaric oxygen in 42.9%. Most patients (85.7%) had no known cardiovascular disease.

Discussion:
Despite being underexplored, evidence suggests a notable escalation in dysrhythmia risk, particularly in patients with pre-existing cardiovascular conditions, following acute CO poisoning. Potential mechanisms for CO-induced dysrhythmias include the strong binding of CO to hemoglobin, resulting in hypoxia-induced myocardial changes, and molecular alterations affecting cardiac voltage-gated channels.

Conclusion:
While the association between acute CO poisoning and dysrhythmias warrants further investigation, emerging evidence underscores the necessity of raising awareness among healthcare providers regarding the potential cardiovascular consequences of CO exposure.