Atrial fibrillation therapy now and in the future: drugs, biologicals, and ablation.
Atrial fibrillation (AF) is a complex disease with multiple inter-relating causes culminating in rapid, seemingly disorganized atrial activation. Therapy targeting AF is rapidly changing and improving. The purpose of this review is to summarize current state-of-the-art diagnostic and therapeutic modalities for treatment of AF. The review focuses on reviewing treatment as it relates to the pathophysiological basis of disease and reviews preclinical and clinical evidence for potential new diagnostic and therapeutic modalities, including imaging, biomarkers, pharmacological therapy, and ablative strategies for AF. Current ablation and drug therapy approaches to treating AF are largely based on treating the arrhythmia once the substrate occurs and is more effective in paroxysmal AF rather than persistent or permanent AF. However, there is much research aimed at prevention strategies, targeting AF substrate, so-called upstream therapy. Improved diagnostics, using imaging, genetics, and biomarkers, are needed to better identify subtypes of AF based on underlying substrate/mechanism to allow more directed therapeutic approaches. In addition, novel antiarrhythmics with more atrial specific effects may reduce limiting proarrhythmic side effects. Advances in ablation therapy are aimed at improving technology to reduce procedure time and in mechanism-targeted approaches.
From the Division of Cardiology, University of California at San Francisco (C.E.W., J.O.); and Division of Cardiology Research, AUST Development, LLC, Mountain View, CA (C.E.W.).
Christopher E
CE
Woods
Jeffrey
J
Olgin
D000200:Action Potentials; D000818:Animals; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D017115:Catheter Ablation / Q000639:trends; D004059:Diffusion of Innovation; D005544:Forecasting; D006325:Heart Atria / Q000187:drug effects / Q000503:physiopathology / Q000601:surgery; D006329:Heart Conduction System / Q000187:drug effects* / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D016896:Treatment Outcome
D000889:Anti-Arrhythmia Agents
arrhythmias, cardiac; atrial fibrillation; catheter ablation