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Objective: We aimed to study the impact of atrial fibrillation (AF) on hospitalization outcomes of abdominal aortic artery (AAA) endovascular aneurysm repair (EVAR) at a large-scale sample size representative of the entire United States (U.S.) population.Methods: We included all adults who were hospitalized in the U.S. for AAA repair with EVAR between 2016 and 2017 using the International Classification of Diseases-10th Revision, Clinical procedural diagnosis codes. The primary outcome was all-cause in-hospital mortality. Secondary outcomes were stroke, myocardial infarction, respiratory failure, acute kidney injury (AKI), bleeding event, vascular complications, aortic dissection, length of stay (LOS), and hospitalization cost. Hospitalization outcomes were modeled using logistic regression for binary outcomes and Poisson or log-gamma regression for count or right-skewed numeric outcomes, respectively.Results: We included a total of 39,330 records for patients with AAA who underwent EVAR. There were 5.940 patients with AF. On multivariable analysis, EVAR patients with AF had significantly higher odds for mortality with adjusted OR 2.06 (95%CI: 1.09-3.91). They also had significantly higher odds for AKI (A-OR: 1.79 (95%CI: 1.38-2.32), p < 0.001), acute myocardial infarction (A-OR: 2.72 (95%CI: 1.39-5.32), p = 0.004), post procedural bleedings (A-OR: 1.51 (95%CI: 1.20-1.89), p < 0.001), LOS (1.35 (95%CI: 1.24-1.47) p < 0.001) and higher cost (A-OR: 1.06 (9% CI, 1.03-1.09) p < 0.001). There was no significant difference in risk of stroke, vascular complications, and aortic dissection.Conclusion: AF is an important independent predictor for mortality and adverse outcomes in patients with AAA undergoing EVAR. [ABSTRACT FROM AUTHOR]