A proposal for new clinical concepts in the management of atrial fibrillation

A. John Camm*, Sana M. Al-Khatib, Hugh Calkins, Jonathan L. Halperin, Paulus Kirchhof, Gregory Y.H. Lip, Stanley Nattel, Jeremy Ruskin, Amitava Banerjee, Dan Blendea, Eduard Guasch, Matthew Needleman, Irina Savelieva, Juan Viles-Gonzalez, Eric S. Williams

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

44 Scopus citations


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.

Original languageEnglish
Pages (from-to)292-302.e1
JournalAmerican Heart Journal
Issue number3
StatePublished - Sep 2012
Externally publishedYes


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