[Hundred years of atrial fibrillation: current knowledge and perspectives]

Area of Science:

• Cardiology
• Electrophysiology

Context:

• Atrial fibrillation (AF) is the most prevalent sustained cardiac arrhythmia.
• AF is associated with increased mortality, cardiovascular morbidity, heart failure, and thromboembolic events like stroke.
• Historically, rhythm control was considered optimal, but recent studies challenge this paradigm.

Purpose:

• To review the current understanding of atrial fibrillation management.
• To evaluate the efficacy of rhythm control versus rate control strategies.
• To highlight the importance of thromboembolism prevention in AF patients.

Summary:

• Recent randomized trials (e.g., AFFIRM, RACE) indicate that rhythm control offers no significant advantage over rate control for older AF patients, particularly those with heart failure.
• Optimal therapeutic strategies for younger, asymptomatic, or less symptomatic AF patients require further investigation.
• The development of safer antiarrhythmic drugs and advancements in non-pharmacological treatments like radiofrequency catheter ablation are ongoing.
• Prevention of thromboembolic events, especially stroke, is crucial and should be guided by risk factors rather than AF type, given the prevalence of asymptomatic episodes.

Impact:

• Challenges the long-held belief in rhythm control as the primary therapy for AF.
• Underscores the critical need for effective thromboembolism prevention strategies.
• Identifies gaps in knowledge regarding optimal AF management in specific patient populations.
• Highlights the evolving landscape of AF treatment, including pharmacological and interventional approaches.