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Wesley T O’Neal,1 Sanjay Venkatesh,2 Stephen T Broughton,2 William F Griffin,3 Elsayed Z Soliman4,5 1Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA; 2Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA; 3Department of Internal Medicine, Medical University of South Carolina, Charleston, SC, USA; 4Department of Internal Medicine, Division of Cardiology, Wake Forest School of Medicine, Winston-Salem, NC, USA; 5Epidemiological Cardiology Research Center, Wake Forest School of Medicine, Winston-Salem, NC, USA Abstract: Atrial fibrillation (AF) is the most common sustained arrhythmia encountered in clinical practice, and it places a substantial burden on the health care system. Despite improvements in our understanding of AF pathophysiology, we have yet to develop targeted preventive therapies. Recently, numerous biological markers have been identified to aid in the prediction of future AF events. Subclinical markers of atrial stress, inflammation, endothelial dysfunction, kidney dysfunction, and atherosclerosis have been linked to AF. The connection between these markers and AF is the identification of subclinical states in which AF propagation is likely to occur, as these conditions are associated with abnormal atrial remodeling and fibrosis. Additionally, several risk scores have been developed to aid in the identification of at-risk patients. The practicing clinician should be aware of these subclinical markers, as several of these markers improve the predictive abilities of current AF risk scores. Knowledge of these subclinical markers also provides clinicians with a better understanding of AF risk factors, and the opportunity to reduce the occurrence of AF by incorporating well-known cardiovascular disease risk factor modification strategies. In this review, we highlight several novel biological markers that have improved our understanding of AF pathophysiology and appraise the utility of these markers to improve our ability to predict future AF events. Keywords: biological markers, prediction, atrial fibrillation