Early and comprehensive management of atrial fibrillation: executive summary of the proceedings from the 2nd AFNET-EHRA consensus conference 'research perspectives in AF'.
Atrial fibrillation (AF) causes important mortality and morbidity on a population-level. So far, we do not have the means to prevent AF or AF-related complications adequately. Therefore, over 70 experts on atrial fibrillation convened for the 2nd AFNET/EHRA consensus conference to suggest directions for research to improve management of AF patients (Appendix 1). The group defined three main areas in need for research in AF: 1. better understanding of the mechanisms of AF; 2. Improving rhythm control monitoring and management; and 3. comprehensive cardiovascular risk management in AF patients. The group put forward the hypothesis that successful therapy of AF and its associated complications will require comprehensive therapy. This applies e.g. to the "old" debate of "rate versus rhythm control", since rhythm control is generally added to underlying (continued) rate control therapy, but also to the emerging debate of "antiarrhythmic drugs versus catheter ablation", of which both may be needed in most patients to maintain sinus rhythm, but also to therapy of conditions that predispose to AF and contribute to cardiovascular complications such as stroke, cognitive decline, heart failure, and acute coronary syndromes. We call for research initiatives aiming at a better understanding of the different causes of AF and its complications, and at development and validation of mechanism-based therapies. The future of AF therapy may require a combination of management of underlying and concomitant conditions, early and comprehensive rhythm control therapy, adequate control of ventricular rate and cardiac function, and continuous therapy to prevent AF-associated complications (e.g. antithrombotic therapy). The reasons for these suggestions are detailed in this paper.
Kirchhof
Paulus
P
Department of Cardiology and Angiology, University Hospital Münster, Albert-Schweitzer-Strasse 33, D-48149 Münster, Germany. kirchhp@uni-muenster.de
Bax
Jeroen
J
Blomstrom-Lundquist
Carina
C
Calkins
Hugh
H
Camm
A John
AJ
Cappato
Ricardo
R
Cosio
Francisco
F
Crijns
Harry
H
Diener
Hans-Christian
HC
Goette
Andreas
A
Israel
Carsten W
CW
Kuck
Karl-Heinz
KH
Lip
Gregory Y H
GY
Nattel
Stanley
S
Page
Richard L
RL
Ravens
Ursula
U
Schotten
Ulrich
U
Steinbeck
Gerhard
G
Vardas
Panos
P
Waldo
Albert
A
Wegscheider
Karl
K
Willems
Stephan
S
Breithardt
Günter
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D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D017115:Catheter Ablation / Q000379:methods; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D010349:Patient Compliance; D012307:Risk Factors; D012308:Risk Management; D020521:Stroke / Q000517:prevention & control
D000889:Anti-Arrhythmia Agents; D005343:Fibrinolytic Agents