TY - JOUR
T1 - A proposal for new clinical concepts in the management of atrial fibrillation
AU - Camm, A. John
AU - Al-Khatib, Sana M.
AU - Calkins, Hugh
AU - Halperin, Jonathan L.
AU - Kirchhof, Paulus
AU - Lip, Gregory Y.H.
AU - Nattel, Stanley
AU - Ruskin, Jeremy
AU - Banerjee, Amitava
AU - Blendea, Dan
AU - Guasch, Eduard
AU - Needleman, Matthew
AU - Savelieva, Irina
AU - Viles-Gonzalez, Juan
AU - Williams, Eric S.
N1 - Funding Information:
Sana M Al-Khatib, MD, received research funding from Bristol Myers Squibb
Funding Information:
Paulus Kirchhof, MD, received consulting fees and honoraria from 3M Medica, MEDA Pharma, AstraZeneca, Bayer Healthcare, Boehringer Ingelheim, Daicchi-Sankyo, MEDA Pharma, Medtronic, Merck, MSD, Otsuka Pharma, Pfizer/ BMS, Sanofi, Servier, Siemens and TAKEDA; research grants from 3M Medica/MEDA Pharma, Cardiovascular Therapeutics, Medtronic, OMRON, Sanofi, St. Jude Medical, German Federal Ministry for Education and Research, Fondation Leducq, German Research Foundation, and the European Union. Travel support was received from the European Society of Cardiology, the European Heart Rhythm Association, and the German Atrial Fibrillation Competence Network.
Funding Information:
Stanley Nattel, MD, has patents awarded or pending to the Montreal Heart Institute, which lists Dr Nattel as inventor or coinventor: (1) Preventing atrial fibrillation with the use of statin drugs (EU patent awarded); (2) TRPC3 channels are critical for regulating fibroblast proliferation in the heart; (3) MiR21 as a target in prevention of atrial fibrillation. He received research funding from AstraZeneca and Xention Labs. He is a consultant for Pierre Fabre, Cardiome, Merck, Bayer, Nyken. He received honoraria for scientific lectures from Sanofi, Pfizer, Boehringer-Ingelheim, Biosense-Webster, and St. Jude.
Funding Information:
Jeremy Ruskin, MD, is a consultant to Atricure, Inc, Arrhythmia Education, Inc, Astellas/Cardiome, Biosense Webster, Inc, Bristol Myers Squibb, CardioInsight, InfoBionic (equity), Medtronic, Inc, Pfizer, Portola (equity), Sanofi Aventis, and Third Rock Ventures; He received fellowship support from Biosense Webster, Inc, Boston Scientific Corp, Medtronic, Inc, and St. Jude Medical.
Funding Information:
Juan Viles-Gonzalez, MD, received consulting fees from Best Doctors, Inc, Web MD, Morgan Stanley, Smith Barney, Merrill Lynch, Mckensie & Co, Gerson Lehrman Group, Daiichi Sankyo Co, LTD, Boehringer Ingelheim, Sanofi; educational grants from Medtronic, Boston Scientific, St. Jude Medical, and Biotronik.
Funding Information:
Logistical and editorial support was provided by Healthcare21 Communications Ltd and was paid for by an unrestricted grant from Sanofi.
PY - 2012/9
Y1 - 2012/9
N2 - 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.
AB - 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.
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U2 - 10.1016/j.ahj.2012.05.017
DO - 10.1016/j.ahj.2012.05.017
M3 - Review article
C2 - 22980294
AN - SCOPUS:84866318589
VL - 164
SP - 292-302.e1
JO - American Heart Journal
JF - American Heart Journal
SN - 0002-8703
IS - 3
ER -