Early management of atrial fibrillation to prevent cardiovascular complications.

Published

Journal Article (Review)

Atrial fibrillation (AF) is generally considered a progressive disease, typically evolving from paroxysmal through persistent to 'permanent' forms, a process attributed to electrical and structural remodelling related to both the underlying disease and AF itself. Medical treatment has yet to demonstrate clinical efficacy in preventing progression. Large clinical trials performed to date have failed to show benefit of rhythm control compared with rate control, but these trials primarily included patients at late stages in the disease process. One possible explanation is that intervention at only an early stage of progression may improve prognosis. Evolving observations about the progressive nature of AF, along with the occurrences of major complications such as strokes upon AF presentation, led to the notion that earlier and more active approaches to AF detection, rhythm-reversion, and maintenance of sinus rhythm may be a useful strategy in AF management. Approaches to early and sustained rhythm control include measures that prevent development of the AF substrate, earlier catheter ablation, and novel antiarrhythmic drugs. Improved classifications of AF mechanism, pathogenesis, and remodelling may be helpful to enable patient-specific pathophysiological diagnosis and therapy. Potential novel therapeutic options under development include microRNA-modulation, heatshock protein inducers, agents that influence Ca(2+) handling, vagal stimulators, and more aggressive mechanism-based ablation strategies. In this review, of research into the basis and management of AF in acute and early settings, it is proposed that progression from paroxysmal to persistent AF can be interrupted, with potentially favourable prognostic impact.

Full Text

Duke Authors

Cited Authors

  • Nattel, S; Guasch, E; Savelieva, I; Cosio, FG; Valverde, I; Halperin, JL; Conroy, JM; Al-Khatib, SM; Hess, PL; Kirchhof, P; De Bono, J; Lip, GYH; Banerjee, A; Ruskin, J; Blendea, D; Camm, AJ

Published Date

  • June 2014

Published In

Volume / Issue

  • 35 / 22

Start / End Page

  • 1448 - 1456

PubMed ID

  • 24536084

Pubmed Central ID

  • 24536084

Electronic International Standard Serial Number (EISSN)

  • 1522-9645

International Standard Serial Number (ISSN)

  • 0195-668X

Digital Object Identifier (DOI)

  • 10.1093/eurheartj/ehu028

Language

  • eng