Should we abandon the term 〝lone atrial fibrillation〞?

Area of Science:

• Cardiology
• Electrophysiology
• Genetics

Background:

• Lone atrial fibrillation (AF) is defined in individuals under 60 without structural heart disease or secondary causes.
• Diagnostic criteria for lone AF remain ambiguous despite its longstanding use.
• The underlying mechanisms of AF, especially in the absence of structural changes, are not fully understood.

Purpose of the Study:

• To review the current understanding of lone AF, including its definition, mechanisms, genetics, biomarkers, and clinical management.
• To critically evaluate the validity and utility of the term "lone AF" in light of recent scientific discoveries.
• To provide recommendations on the future classification and management of this condition.

Main Methods:

• Comprehensive literature review of studies on lone AF.
• Analysis of electrophysiological elements, genetic variations, and microRNA roles in AF pathogenesis.
• Examination of biomarker correlations and associated comorbidities in lone AF patients.

Main Results:

• Lone AF pathogenesis involves triggers, substrates, modulators, microRNAs, and genomic variations.
• Evidence suggests coexistent disorders and diverse pathogenic factors in individuals with lone AF.
• The classification of lone AF has not resulted in distinct clinical management strategies.

Conclusions:

• The term "lone AF" is increasingly questionable due to the recognition of numerous underlying causes.
• The lack of unique clinical management strategies further undermines the term's significance.
• Abandoning the term "lone AF" is suggested due to its perceived futility and ambiguity.