title: Expert consensus document: Defining the major health modifiers causing atrial fibrillation: a roadmap to underpin personalized prevention and treatment.
abstract: Despite remarkable advances in antiarrhythmic drugs, ablation procedures, and stroke-prevention strategies, atrial fibrillation (AF) remains an important cause of death and disability in middle-aged and elderly individuals. Unstructured management of patients with AF sharply contrasts with our detailed, although incomplete, knowledge of the mechanisms that cause AF and its complications. Altered calcium homeostasis, atrial fibrosis and ageing, ion-channel dysfunction, autonomic imbalance, fat-cell infiltration, and oxidative stress, in addition to a susceptible genetic background, contribute to the promotion, maintenance, and progression of AF. However, clinical management of patients with AF is currently guided by stroke risk parameters, AF pattern, and symptoms. In response to this apparent disconnect between the known pathophysiology of AF and clinical management, we propose a roadmap to develop a set of clinical markers that reflect the major causes of AF in patients. Thereby, the insights into the mechanisms causing AF will be transformed into a format that can underpin future personalized strategies to prevent and treat AF, ultimately informing better patient care.
authors.affiliation: Institute of Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.|Department of Cardiovascular Medicine, Division of Rhythmology, University Hospital Münster, Schlossplatz 2, 48149 Munich, Germany.
authors.forename: Larissa
authors.initials: L
authors.lastname: Fabritz
authors.affiliation: Hospital Clinic de Barcelona, Villarroel, 170, 08036 Barcelona, Spain.|Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Carrer del Rosselló, 149, 08036 Barcelona, Spain.
authors.forename: Eduard
authors.initials: E
authors.lastname: Guasch
authors.affiliation: Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK.
authors.forename: Charalambos
authors.initials: C
authors.lastname: Antoniades
authors.affiliation: European Society of Cardiology, 2035 Route des Colles, 06903 Sophia Antipolis, France.
authors.forename: Isabel
authors.initials: I
authors.lastname: Bardinet
authors.affiliation: Atrial Fibrillation Network (AFNET) Association, Mendelstraße 11, 48149 Munich, Germany.
authors.forename: Gerlinde
authors.initials: G
authors.lastname: Benninger
authors.affiliation: Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK.
authors.forename: Tim R
authors.initials: TR
authors.lastname: Betts
authors.affiliation: Internal Medicine D, Department of Nephrology, Hypertension and Rheumatology, University Hospital Münster, Schlossplatz 2, 48149 Munich, Germany.
authors.forename: Eva
authors.initials: E
authors.lastname: Brand
authors.affiliation: Department of Cardiovascular Medicine, Division of Rhythmology, University Hospital Münster, Schlossplatz 2, 48149 Munich, Germany.|Atrial Fibrillation Network (AFNET) Association, Mendelstraße 11, 48149 Munich, Germany.
authors.forename: Günter
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authors.lastname: Breithardt
authors.affiliation: Roche Professional Diagnostics, Forrenstrasse 2, CH-6343 Rotkreuz, Switzerland.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Bucklar-Suchankova
authors.affiliation: Cardiovascular Sciences Research Centre, St George's University of London, Cranmer Terrace, London SW17 0RE, UK.|Imperial College London, London SW7 2AZ, UK.
authors.forename: A John
authors.initials: AJ
authors.lastname: Camm
authors.affiliation: UK Health and Environmental Research Institute, Pera Technology, Nottingham Road, Melton Mowbray LE13 0PB, UK.
authors.forename: David
authors.initials: D
authors.lastname: Cartlidge
authors.affiliation: Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK.
authors.forename: Barbara
authors.initials: B
authors.lastname: Casadei
authors.affiliation: Institute of Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
authors.forename: Winnie W L
authors.initials: WW
authors.lastname: Chua
authors.affiliation: Cardiovascular Research Institute Maastricht (CARIM), 6229 ER Maastricht, Netherlands.|Maastricht Centre of Systems Biology (MaCSBio), Maastricht University, 6200 MD Maastricht, Netherlands.
authors.forename: Harry J G M
authors.initials: HJ
authors.lastname: Crijns
authors.affiliation: Department of Public Health, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
authors.forename: Jon
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authors.lastname: Deeks
authors.affiliation: UPMC Université Paris, 4 Place Jussieu, 75005 Paris, France.
authors.forename: Stéphane
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authors.affiliation: UPMC Université Paris, 4 Place Jussieu, 75005 Paris, France.
authors.forename: Françoise
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authors.lastname: Hidden-Lucet
authors.affiliation: University Hospital Munich, Department of Medicine I, Ludwig-Maximilians University, Professor-Huber-Platz 2, 80539 Munich, Germany.|German Cardiovascular Research Center (DZKH), partner site: Munich Heart Alliance, Munich, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Kääb
authors.affiliation: National School of Public Health, Leof. Alexandras 196, Athens, Greece.
authors.forename: Nikos
authors.initials: N
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authors.affiliation: European Society of Cardiology, 2035 Route des Colles, 06903 Sophia Antipolis, France.
authors.forename: Stephan
authors.initials: S
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authors.affiliation: Hospital Clinic de Barcelona, Villarroel, 170, 08036 Barcelona, Spain.|Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Carrer del Rosselló, 149, 08036 Barcelona, Spain.
authors.forename: Lluis
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authors.lastname: Mont
authors.affiliation: Division of Vascular Medicine, Department of Cardiovascular Medicine, University Hospital of Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149 Munich, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Reinecke
authors.affiliation: University Hospital Munich, Department of Medicine I, Ludwig-Maximilians University, Professor-Huber-Platz 2, 80539 Munich, Germany.
authors.forename: Moritz F
authors.initials: MF
authors.lastname: Sinner
authors.affiliation: Cardiovascular Research Institute Maastricht (CARIM), 6229 ER Maastricht, Netherlands.|Maastricht Centre of Systems Biology (MaCSBio), Maastricht University, 6200 MD Maastricht, Netherlands.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Schotten
authors.affiliation: School of Immunity and Infection, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
authors.forename: Taunton
authors.initials: T
authors.lastname: Southwood
authors.affiliation: Cardiovascular Research Institute Maastricht (CARIM), 6229 ER Maastricht, Netherlands.|Maastricht Centre of Systems Biology (MaCSBio), Maastricht University, 6200 MD Maastricht, Netherlands.
authors.forename: Monika
authors.initials: M
authors.lastname: Stoll
authors.affiliation: University of Crete, Heraklion GR-71003, Greece.
authors.forename: Panos
authors.initials: P
authors.lastname: Vardas
authors.affiliation: University Hospital Munich, Department of Medicine I, Ludwig-Maximilians University, Professor-Huber-Platz 2, 80539 Munich, Germany.|German Cardiovascular Research Center (DZKH), partner site: Munich Heart Alliance, Munich, Germany.
authors.forename: Reza
authors.initials: R
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authors.affiliation: UK Health and Environmental Research Institute, Pera Technology, Nottingham Road, Melton Mowbray LE13 0PB, UK.
authors.forename: Andy
authors.initials: A
authors.lastname: West
authors.affiliation: Roche Professional Diagnostics, Forrenstrasse 2, CH-6343 Rotkreuz, Switzerland.
authors.forename: André
authors.initials: A
authors.lastname: Ziegler
authors.affiliation: Institute of Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.|Department of Cardiovascular Medicine, Division of Rhythmology, University Hospital Münster, Schlossplatz 2, 48149 Munich, Germany.|Atrial Fibrillation Network (AFNET) Association, Mendelstraße 11, 48149 Munich, Germany.|SWBH NHS Trust, Dudley Road, Birmingham, West Midlands B18 7QH, UK.|UHB NHS Trust, Mindelsohn Way, Edgbaston, Birmingham B15 2TH, UK.
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authors.lastname: Kirchhof
mesh_terms: D000818:Animals; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control*; D002309:Cardiology / Q000592:standards*; D032921:Consensus; D006801:Humans; D057285:Precision Medicine / Q000592:standards*; D011237:Predictive Value of Tests; D011314:Preventive Health Services / Q000592:standards*; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome