New concepts in understanding and modulating atrial repolarisation in patients with atrial fibrillation

Atrial fibrillation is the most frequent cardiac arrhythmia in clinical practice. Although much has been learned, the underlying mechanisms are incompletely understood. Clinically used antiarrhythmic drugs are limited in their efficacy to terminate atrial fibrillation or to maintain sinus rhythm and were associated with substantial toxicity including life-threatening ventricular arrhythmias. Novel therapeutic approaches suggest targeting of atrium-selective ion channels and pathology-specific alterations in atrial repolarisation and arrhythmogenesis as promising drug targets for patients with atrial fibrillation. This article focuses on novel aspects of altered atrial repolarisation and discusses atrium-selective (I(Kur), I(K,ACh)) and pathology-specific (I(K,ACh)) ion channels as potential targets for safe and effective treatment of atrial fibrillation.