title: A proposal for new clinical concepts in the management of atrial fibrillation.
abstract: Atrial fibrillation (AF) represents a growing public health burden. It is a complex condition, involving a number of etiologic factors and arrhythmia mechanisms associated with atrial remodeling. Greater understanding of these mechanisms may improve therapy. Current AF classification schemes are limited by simplicity. A number of risk factors predict AF onset, and additional factors are being evaluated in registry studies. Doppler imaging and Holter monitoring in high-risk patients to predict the onset of AF and progression from paroxysmal to permanent AF are promising. There is a need for a novel multifactorial classification model encompassing AF duration, symptoms, markers of atrial remodeling, and a risk score for AF onset, persistence, progression, and complications to guide treatment and prognostication. Preventing AF onset with upstream therapy is of great interest, but current data are conflicting. More study is needed to optimize rhythm control with antiarrhythmic drugs and targeted ablation to specific patient populations at an earlier stage. There is little consensus on optimal rate control and no information relating to optimum rate control in specific populations. This article highlights new concepts in AF and directions for future research.
authors.affiliation: St George's, University of London, United Kingdom. jcamm@sgul.ac.uk
authors.forename: A John
authors.initials: AJ
authors.lastname: Camm
authors.forename: Sana M
authors.initials: SM
authors.lastname: Al-Khatib
authors.forename: Hugh
authors.initials: H
authors.lastname: Calkins
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Halperin
authors.forename: Paulus
authors.initials: P
authors.lastname: Kirchhof
authors.forename: Gregory Y H
authors.initials: GY
authors.lastname: Lip
authors.forename: Stanley
authors.initials: S
authors.lastname: Nattel
authors.forename: Jeremy
authors.initials: J
authors.lastname: Ruskin
authors.forename: Amitava
authors.initials: A
authors.lastname: Banerjee
authors.forename: Dan
authors.initials: D
authors.lastname: Blendea
authors.forename: Eduard
authors.initials: E
authors.lastname: Guasch
authors.forename: Matthew
authors.initials: M
authors.lastname: Needleman
authors.forename: Irina
authors.initials: I
authors.lastname: Savelieva
authors.forename: Juan
authors.initials: J
authors.lastname: Viles-Gonzalez
authors.forename: Eric S
authors.initials: ES
authors.lastname: Williams
mesh_terms: D001281:Atrial Fibrillation / Q000145:classification / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006801:Humans