Background and aims: Metabolic syndrome (MS) might influence the course of atrial fibrillation (AF) similarly to diabetes (DM). Aim of this research is to evaluate the quality of life, disease burden and medication adherence of patients with different metabolic states. Material and methods: A cross-sectional study of Latvian Center of Cardiology Arrhythmology Department patients with AF, sorting patients in 3 categories according to the National Institutes for Health guidelines criteria for MS. Results: From 133 patients, 51 were in metabolically healthy (MH) group, 58 in MS group and 24 had DM. Average age was 62.59 in MH, 67.59 in MS and 66.25 in DM group. Most common form of AF was persistent - MH 49%, MS 65.5%, DM 75%. Best EHRA median value was observed in DM group (29.2% reporting mild symptoms). Majority of patients had 1-2 comorbidities in MH and MS group and 3-5 in the DM group, with almost all patients using 4-9 drugs daily. Conclusions: A similar course of AF was observed in MS and DM groups. Since the same molecular pathways are involved, MS should be viewed as a cluster of risk factors with a cumulative effect - greater than the effect of a single risk factor.