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Updated: Mar 28, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Expert consensus document: Defining the major health modifiers causing atrial fibrillation: a roadmap to underpin
Larissa Fabritz1,2, Eduard Guasch3,4, Charalambos Antoniades5
1Institute of Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
Insights
Atrial fibrillation (AF) management lags behind understanding of its causes. This study proposes developing clinical markers reflecting AF mechanisms for personalized prevention and treatment strategies.
Area of Science:
- Cardiology
- Biomedical Research
- Translational Medicine
Background:
- Atrial fibrillation (AF) persists as a major cause of mortality and morbidity despite advances in treatment.
- Current AF management relies on stroke risk, pattern, and symptoms, not underlying pathophysiology.
- Significant knowledge exists on AF mechanisms including calcium dysregulation, fibrosis, and autonomic imbalance.
Purpose of the Study:
- To bridge the gap between AF pathophysiology and clinical practice.
- To propose a roadmap for developing clinical markers for AF causes.
- To enable personalized AF prevention and treatment strategies.
Main Methods:
- Literature review of AF mechanisms and clinical management.
- Conceptual framework development for clinical marker identification.
- Roadmap proposal for translating mechanistic insights into clinical tools.
Main Results:
- Identified a disconnect between AF mechanistic understanding and current clinical management.
- Proposed a strategy to develop clinical markers reflecting key AF drivers.
- Outlined a path towards personalized AF care.
Conclusions:
- Developing clinical markers based on AF pathophysiology is crucial.
- Personalized strategies informed by these markers can improve AF patient care.
- Translating mechanistic insights into actionable clinical tools is the future of AF management.
Abstract:
Despite remarkable advances in antiarrhythmic drugs, ablation procedures, and stroke-prevention strategies, atrial fibrillation (AF) remains an important cause of death and disability in middle-aged and elderly individuals. Unstructured management of patients with AF sharply contrasts with our detailed, although incomplete, knowledge of the mechanisms that cause AF and its complications. Altered calcium homeostasis, atrial fibrosis and ageing, ion-channel dysfunction, autonomic imbalance, fat-cell infiltration, and oxidative stress, in addition to a susceptible genetic background, contribute to the promotion, maintenance, and progression of AF. However, clinical management of patients with AF is currently guided by stroke risk parameters, AF pattern, and symptoms. In response to this apparent disconnect between the known pathophysiology of AF and clinical management, we propose a roadmap to develop a set of clinical markers that reflect the major causes of AF in patients. Thereby, the insights into the mechanisms causing AF will be transformed into a format that can underpin future personalized strategies to prevent and treat AF, ultimately informing better patient care.
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