Curriculum in CardiologyA proposal for new clinical concepts in the management of atrial fibrillation
Section snippets
Methods
The group is organized into a working group, which reviewed and collated available evidence, and a scientific committee, which highlighted areas where evidence is lacking and progress is needed. The AF Science Evolution group was formed with the aid of an unrestricted educational grant from Sanofi. Members of the scientific committee received an honorarium and travelling expenses to attend a meeting in July 2011. Members of the working group received an honorarium for their time during a number
Overview of mechanistic determinants of AF
The mechanisms underlying AF are multifactorial and challenging to pinpoint on an individual case basis.2 Figure 1A depicts the principal determinants of clinical AF as 3 concentric rings. The etiologic dimension (outermost ring) includes clinical promoters of AF. The second ring describes the atrial remodeling that underlies the electrophysiology responsible for AF. The inner ring encompasses basic arrhythmia mechanisms responsible for induction and maintenance of AF. These are further
Current classification systems for AF
The current classification system adopted by the American College of Cardiology/American Heart Association/European Society of Cardiology/Heart Rhythm Society (ACC/AHA/ESC/HRS) guidelines5 is based on the pattern and duration of AF. Arrhythmia is classified as paroxysmal (resolving spontaneously), persistent (≥ 7 days in duration), or permanent, and as “first-detected” or “recurrent.” Classification as permanent is based on the patient and physician deciding not to attempt to restore or maintain
Therapeutic options in achieving rhythm control
Potential advantages of a rhythm control strategy include improved cardiac function, symptom relief, improved quality of life, and avoidance of unfavorable atrial electrical and mechanical remodeling. There are 2 major options for achieving rhythm control in patients with AF: pharmacologic treatment and ablation.
Conclusions
This article highlights several new directions for research in AF. Further characterization of the mechanisms underlying AF and greater understanding of AF progression will lead to better application of preventive therapies and improve prognosis.
Disclosures
A John Camm, MD, is an advisor and speaker for Sanofi, Merck, Gilead, Menarini, Medtronic, and Boston Scientific.
Sana M Al-Khatib, MD, received research funding from Bristol Myers Squibb
Hugh J Calkins, MD, is a consultant to Biosense Webster, Medtronic, and Atricure, and Sanofi.
Jonathon L Halperin, MD, received consulting fees from Astellas Pharma, US, Atricure/Boston Biomedical Associates, AstraZeneca, Bayer AG HealthCare, Boehringer Ingelheim, Pharmaceuticals, Inc, Bristol Meyers-Squibb,
Acknowledgements
Logistical and editorial support was provided by Healthcare21 Communications Ltd and was paid for by an unrestricted grant from Sanofi.
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