title: Tailored treatment strategies: a new approach for modern management of atrial fibrillation.
abstract: Atrial fibrillation (AF) is not benign. Cardiovascular diseases and risk factors differ importantly amongst patients. Careful phenotyping with the aim to start tailored therapy may improve outcome and quality of life. Furthermore, structural remodelling plays an important role in initiation and progression of AF. Therapies that interfere in the remodelling processes are promising because they may modify the atrial substrate. However, success is still limited probably due to variations in the underlying substrate in individual patients. The most favourable effects of lifestyle changes on success of rhythm control have been demonstrated in obese patients with AF. Differences in genotype may also play an important role. Common gene variants have been associated with recurrence of AF after electrical cardioversion, antiarrhythmic drug therapy and catheter ablation. Therefore, both phenotyping and genotyping may become useful for patient selection in the future. Beside the choice of rate or rhythm control, and type of rhythm control, prevention of complications associated with AF may also differ depending on genotype and phenotype. Efficacy of stroke prevention has been well established, but bleeding remains a clinically relevant problem. Risk stratification is still cumbersome, especially in low-risk patients and in those with a high bleeding risk. The decision whether to start anticoagulation (and if so which type of anticoagulant) or, alternatively, to implant an occlusion device of the left atrial appendage may also be improved by genotyping and phenotyping. In this review, we will summarize new insights into the roles of phenotype and genotype in generating more tailored treatment strategies in patients with AF and discuss several patient-tailored treatment options.
authors.affiliation: Department of Cardiology, Thoraxcenter, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: I C
authors.initials: IC
authors.lastname: Van Gelder
authors.affiliation: Department of Cardiology, Thoraxcenter, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: A H
authors.initials: AH
authors.lastname: Hobbelt
authors.affiliation: Department of Cardiology, Thoraxcenter, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: E G
authors.initials: EG
authors.lastname: Marcos
authors.affiliation: Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht Centre for Systems Biology, Maastricht, The Netherlands.
authors.forename: U
authors.initials: U
authors.lastname: Schotten
authors.affiliation: Humanitas Clinical and Research Center, Milan, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Cappato
authors.affiliation: Department of Medicine-Cardiology and Intensive Care, Peter Osypka Heart Center Munich, Hospital Munich-Thalkirchen, Munich, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Lewalter
authors.affiliation: Department of Cardiology, Karolinksa Insitute, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: J
authors.initials: J
authors.lastname: Schwieler
authors.affiliation: Department of Cardiology, Thoraxcenter, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Rienstra
authors.affiliation: Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S.Orsola-Malpighi University Hospital, Bologna, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Boriani
mesh_terms: D000328:Adult; D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000628:therapy*; D015415:Biomarkers / Q000097:blood; D017115:Catheter Ablation / Q000379:methods; D005260:Female; D005838:Genotype; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications; D008297:Male; D008875:Middle Aged; D010641:Phenotype; D057285:Precision Medicine / Q000379:methods; D012008:Recurrence; D012307:Risk Factors
chemical_list: D000889:Anti-Arrhythmia Agents; D000925:Anticoagulants; D015415:Biomarkers
keywords: anticoagulation; arrhythmia; atrial fibrillation; catheter ablation; genetics; risk factors