Can we improve outcomes in AF patients by early therapy?

Paulus Kirchhof

doi:10.1186/1741-7015-7-72

Abstract

Atrial fibrillation affects at least 1% of the population and causes marked society-wide morbidity and mortality. Current management of atrial fibrillation including antithrombotic therapy and management of concomitant conditions in all patients, rate control therapy in most patients, and rhythm control therapy in patients with severe atrial fibrillation-related symptoms can alleviate atrial fibrillation-related symptoms but can neither effectively prevent recurrent atrial fibrillation nor suppress atrial fibrillation-related complications. Hence, there is a need for better therapy of atrial fibrillation.The etiology of atrial fibrillation is complex. Most of the causes of atrial fibrillation which are known at present perpetuate themselves in vicious circles, and presence of the arrhythmia by itself causes marked damage of atrial myocardium. These pathophysiological insights suggest that early diagnosis and comprehensive therapy of atrial fibrillation, including adequate therapy of all atrial fibrillation-causing conditions, rate control, and rhythm control therapy, could help to prevent progression of atrial fibrillation and reduce atrial fibrillation-related complications. Such a therapy should make use of safe and effective therapeutic modalities, some of which have become available recently or will become available in the near future. The hypothesis that early diagnosis and early, comprehensive therapy of atrial fibrillation can improve outcomes requires formal testing in controlled trials.

Highlights

D [4,5]. Rather, most patients progress from paroxysmal atrial fibrillation (AF), that is, AF that alternates with periods of sinus rhythm, to sustained forms (Figure 1), even when currently available therapeutic options are applied
Death rates are increased in patients with a myocardial infarction or in heart failure patients when atrial fibrillation (AF) is added to their disease pattern
One example is the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) trial population in which presence of sinus rhythm during followup associated with better survival, while therapy with antiarrhythmic drugs associated with earlier death [39]

Summary

Introduction

D [4,5]. Rather, most patients progress from paroxysmal AF, that is, AF that alternates with periods of sinus rhythm, to sustained forms (Figure 1), even when currently available therapeutic options are applied. One of the reasons why AF is so difficult to cure is probably the complex etiology of the arrhythmia as recently outlined in two consensus conferences on AF [6,7]: AF can be caused by atrial structural damage conferred by cardiac or extracardiac disease and rapid irregular ventricular rate [8,9], a sign of natural ageing of the heart, and an electrical (page number not for citation purposes)

Results

Conclusion