Delayed rhythm control of atrial fibrillation may be a cause of failure to prevent recurrences: reasons for change to active antiarrhythmic treatment at the time of the first detected episode.
Atrial fibrillation (AF) is associated with impaired functional capacity and quality of life and significant morbidity and mortality. The current management approach fails to maintain stable sinus rhythm (SR) in the majority of patients. For many years, guidelines have recommended antiarrhythmic treatment of a first AF episode only if the AF is poorly tolerated, a position that has been reinforced by studies showing no mortality or morbidity advantage of rhythm control over rate control. During the last decade, research has shown mechanisms of self-perpetuation of AF based on electrophysiological and structural remodelling induced by AF itself. There is mounting evidence that 'lone' AF is because of a host of factors, some of which may be easily treatable, such as hypertension, sleep apnoea, and obesity, thus allowing secondary prevention at the time of the first episode of AF. According to these concepts, lack of early intervention could be one of the reasons for long-term failure of maintenance of SR. In this position paper, we propose testing the working hypothesis that if an SR maintenance strategy is selected, treatment of AF should commence at the first-detected episode and should be based on a double strategy of SR restoration and aggressive treatment of associated conditions that promote atrial remodelling.
Cosio
Francisco G
FG
Hospital Universitario de Getafe, Carretera de Toledo, km 12,5 Getafe, 28905 Madrid, Spain. fgarciacosio.hugf@salud.madrid.org
Aliot
Etienne
E
Botto
Giovanni Luca
GL
Heidbüchel
Hein
H
Geller
Christoph Johan
CJ
Kirchhof
Paulus
P
De Haro
Jean-Claude
JC
Frank
Robert
R
Villacastin
Julian Perez
JP
Vijgen
Johan
J
Crijns
Harry
H
D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000503:physiopathology* / Q000517:prevention & control*; D002304:Cardiac Pacing, Artificial; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D055502:Secondary Prevention; D012849:Sinoatrial Node / Q000503:physiopathology
D000889:Anti-Arrhythmia Agents