title: The impact of new and emerging clinical data on treatment strategies for atrial fibrillation.
abstract: BACKGROUND
  The Atrial Fibrillation (AF) Exchange Group, an international multidisciplinary group concerned with the management of AF, was convened to review recent advances in the field and the potential impact on treatment strategies.
  
  
  METHODS
  Issues discussed included epidemiology and the impact of the rising incidence of AF on health care systems, developments in pharmacological and surgical interventions in the management of arrhythmias and thromboprophylaxis, the potential to affect treatment strategies, and barriers to implementing them.
  
  
  RESULTS
  The incidence of AF and the associated burden on health care systems are increasing with aging populations, prevalence of comorbidities and more effective treatment of cardiovascular diseases. Advances in available medical treatments, in particular dronedarone and dabigatran, with other products in development, offer the possibility of changes in treatment paradigms and a greater emphasis on reducing hospitalizations and improvement in long-term outcomes instead of a symptom/safety-driven approach in which the priority is symptom suppression without provoking drug toxicity. Developments in catheter ablation techniques may mean that, in experienced centers, ablation may be offered as first-line treatment in selected patient populations. Barriers to optimal treatment include underdiagnosis, lack of recognition as a serious condition and as a risk factor for stroke, limited access to care, inadequate implementation of guidelines, and poor adherence to treatment.
  
  
  CONCLUSIONS
  The focus of the management of AF may be changing as a consequence of new treatments based on the outcome improvements they offer. However, the benefits will not be fully realized if guidelines and guidance are not observed in routine clinical practice.
authors.affiliation: The Care Group, 8333 Naab Road, Indianapolis, IN 46260, USA. eprystow@TheCareGroup.com
authors.forename: Eric N
authors.initials: EN
authors.lastname: Prystowsky
authors.forename: John
authors.initials: J
authors.lastname: Camm
authors.forename: Gregory Y H
authors.initials: GY
authors.lastname: Lip
authors.forename: Maurits
authors.initials: M
authors.lastname: Allessie
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Bergmann
authors.forename: Günter
authors.initials: G
authors.lastname: Breithardt
authors.forename: Josep
authors.initials: J
authors.lastname: Brugada
authors.forename: Harry
authors.initials: H
authors.lastname: Crijns
authors.forename: Patrick T
authors.initials: PT
authors.lastname: Ellinor
authors.forename: Daniel
authors.initials: D
authors.lastname: Mark
authors.forename: Gerald
authors.initials: G
authors.lastname: Naccarelli
authors.forename: Douglas
authors.initials: D
authors.lastname: Packer
authors.forename: Juan
authors.initials: J
authors.lastname: Tamargo
mesh_terms: D000889:Anti-Arrhythmia Agents / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D017115:Catheter Ablation / Q000009:adverse effects / Q000191:economics; D019317:Evidence-Based Medicine; D019983:Guideline Adherence; D017048:Health Care Costs; D006801:Humans; D015994:Incidence; D017410:Practice Guidelines as Topic; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents