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Chung, Mina K.; Refaat, Marwan; Shen, Win-Kuang; Kutyifa, Valentina; Cha, Yong-Mei; Di Biase, Luigi; Baranchuk, Adrian; Lampert, Rachel; Natale, Andrea; Fisher, John; Lakkireddy, Dhanunjaya R.
Journal of the American College of Cardiology, 04/2020, Volume: 75, Issue: 14Journal Article
Atrial fibrillation (AF) is an increasingly prevalent arrhythmia; its pathophysiology and progression are well studied. Stroke and bleeding risk models have been created and validated. Decision tools for stroke prophylaxis are evolving, with better options at hand. Utilization of various diagnostic tools offer insight into AF burden and thromboembolic risk. Rate control, rhythm control, and stroke prophylaxis are the cornerstones of AF therapy. Although antiarrhythmic drugs are useful, AF ablation has become a primary therapeutic strategy. Pulmonary vein isolation is the cornerstone of AF ablation, and methods to improve ablation safety and efficacy continue to progress. Ablation of nonpulmonary vein sites is increasingly being recognized as an important strategy for treating nonparoxysmal AF. Several new ablation techniques and technologies and stroke prophylaxis are being explored. This is a contemporary review on the prevalence, pathophysiology, risk prediction, prophylaxis, treatment options, new insights for optimizing treatment outcomes, and emerging concepts of AF. Display omitted •AF is a cardiovascular pandemic with a complex pathophysiology and contributes to significant patient morbidity and mortality.•Emphasis is on early detection and intervention for stroke prophylaxis and disease progression.•Significant progress has been made in paroxysmal AF, but better understanding is needed on substrate progression, evolution of non-PV triggers, and a comprehensive approach to multisystem risk factor modification.
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