Atrial fibrillation: current understandings and research imperatives. The National Heart, Lung, and Blood Institute Working Group on Atrial Fibrillation

Atrial fibrillation is the most common sustained cardiac arrhythmia encountered in clinical practice. Atrial fibrillation increases with age and is relatively common (> 5%) in patients > 69 years old. Despite this, our understanding of the underlying electrophysiologic mechanisms and the optimal management remains incomplete. This arrhythmia is seen most frequently in association with coronary disease or hypertension, but it is also frequently a consequence of rheumatic heart disease. The mechanism of atrial fibrillation requires further elucidation, but the most widely accepted hypothesis is a multiple reentrant wavelet mechanism. The treatment of atrial fibrillation is undertaken to reduce the risk of stroke or systemic embolus, to control palpitation or other symptoms or to improve exercise tolerance or treat pulmonary congestion. This report is a discussion of the epidemiology of atrial fibrillation and of the etiology, mechanism, management and future research directions in the study of this arrhythmia.

This article has been cited by other articles:

				T. Sueda, K. Imai, K. Orihashi, T. Takasaki, S. Takahashi, and T. Kurosaki Late Occurrence of Atrial Arrhythmias After the Simple Left Atrial Procedure for Chronic Atrial Fibrillation in Mitral Valve Surgery Ann. Thorac. Surg., December 1, 2010; 90(6): 1959 - 1966. [Abstract] [Full Text] [PDF]

				A. Nair, B. Sealove, J. L. Halperin, G. Webber, and V. Fuster Anticoagulation in patients with heart failure: who, when, and why? Eur. Heart J. Suppl., September 1, 2006; 8(suppl_E): E32 - E38. [Abstract] [Full Text] [PDF]

				S. Saba, A. M. Janczewski, L. C. Baker, V. Shusterman, E. C. Gursoy, A. M. Feldman, G. Salama, C. F. McTiernan, and B. London Atrial contractile dysfunction, fibrosis, and arrhythmias in a mouse model of cardiomyopathy secondary to cardiac-specific overexpression of tumor necrosis factor-{alpha} Am J Physiol Heart Circ Physiol, October 1, 2005; 289(4): H1456 - H1467. [Abstract] [Full Text] [PDF]

				Y. Kang, B. J. Daly, and J.-S. Kim Uncertainty and Its Antecedents in Patients With A trial Fibrillation West J Nurs Res, November 1, 2004; 26(7): 770 - 783. [Abstract] [PDF]

				Z R Yousef, S C Tandy, V Tudor, F Jishi, R J Trent, D K Watson, and R P W Cowell Warfarin for non-rheumatic atrial fibrillation: five year experience in a district general hospital Heart, November 1, 2004; 90(11): 1259 - 1262. [Abstract] [Full Text] [PDF]

				C.J. Boos, J. Carlsson, and R.S. More Rate or rhythm control in persistent atrial fibrillation? QJM, December 1, 2003; 96(12): 881 - 892. [Abstract] [Full Text] [PDF]

				C. Boixel, V. Fontaine, C. Rucker-Martin, P. Milliez, L. Louedec, J.-B. Michel, M.-P. Jacob, and S. N. Hatem Fibrosis of the left atria during progression of heart failure is associated with increased matrix metalloproteinases in the rat J. Am. Coll. Cardiol., July 16, 2003; 42(2): 336 - 344. [Abstract] [Full Text] [PDF]

				The AFFIRM First Antiarrhythmic Drug Substudy Inve Maintenance of sinus rhythm in patients with atrial fibrillation: An AFFIRM substudy of the first antiarrhythmic drug J. Am. Coll. Cardiol., July 2, 2003; 42(1): 20 - 29. [Abstract] [Full Text] [PDF]

				A Wakai and J O O'Neill Emergency management of atrial fibrillation Postgrad. Med. J., June 1, 2003; 79(932): 313 - 319. [Abstract] [Full Text] [PDF]

				D. G. Wyse Rhythm management in atrial fibrillation: less is more J. Am. Coll. Cardiol., May 21, 2003; 41(10): 1703 - 1706. [Full Text] [PDF]

				N. Kondo, K. Takahashi, M. Minakawa, and K. Daitoku Left atrial Maze procedure: a useful addition to other corrective operations Ann. Thorac. Surg., May 1, 2003; 75(5): 1490 - 1494. [Abstract] [Full Text] [PDF]

				Y.-M. Cha, P. P. Dzeja, W. K. Shen, A. Jahangir, C. Y. T. Hart, A. Terzic, and M. M. Redfield Failing atrial myocardium: energetic deficits accompany structural remodeling and electrical instability Am J Physiol Heart Circ Physiol, April 1, 2003; 284(4): H1313 - H1320. [Abstract] [Full Text] [PDF]

				D. P. Schutte, M. R. Essop, N. M. Ammash, A. J. Tajik, J. B. Seward, W. D. Edwards, and K. R. Bailey Clinical Profile and Outcome of Idiopathic Restrictive Cardiomyopathy Response Circulation, April 10, 2001; 103(14): e83 - e83. [Full Text] [PDF]

				K. Imai, T. Sueda, K. Orihashi, M. Watari, and Y. Matsuura Clinical analysis of results of a simple left atrial procedure for chronic atrial fibrillation Ann. Thorac. Surg., February 1, 2001; 71(2): 577 - 581. [Abstract] [Full Text] [PDF]

				J. Mathew, S. Hunsberger, J. Fleg, F. Mc Sherry, W. Williford, and S. Yusuf Incidence, Predictive Factors, and Prognostic Significance of Supraventricular Tachyarrhythmias in Congestive Heart Failure Chest, October 1, 2000; 118(4): 914 - 922. [Abstract] [Full Text] [PDF]

				A. G. Zaman, R. A. Archbold, G. Helft, E. A. Paul, N. P. Curzen, and P. G. Mills Atrial Fibrillation After Coronary Artery Bypass Surgery : A Model for Preoperative Risk Stratification Circulation, March 28, 2000; 101(12): 1403 - 1408. [Abstract] [Full Text] [PDF]

				C. Aime-Sempe, T. Folliguet, C. Rucker-Martin, M. Krajewska, S. Krajewski, M. Heimburger, M. Aubier, J.-J. Mercadier, J. C. Reed, and S. N. Hatem Myocardial cell death in fibrillating and dilated human right atria J. Am. Coll. Cardiol., November 1, 1999; 34(5): 1577 - 1586. [Abstract] [Full Text] [PDF]

				R. F. Bosch, X. Zeng, J. B. Grammer, K. Popovic, C. Mewis, and V. Kuhlkamp Ionic mechanisms of electrical remodeling in human atrial fibrillation Cardiovasc Res, October 1, 1999; 44(1): 121 - 131. [Abstract] [Full Text] [PDF]

				A. M. Carter, A. J. Catto, and P. J. Grant Association of the {alpha}-Fibrinogen Thr312Ala Polymorphism With Poststroke Mortality in Subjects With Atrial Fibrillation Circulation, May 11, 1999; 99(18): 2423 - 2426. [Abstract] [Full Text] [PDF]

				I. C. Van Gelder, H. J. G. M. Crijns, R. G. Tieleman, J. Brugemann, P. J. De Kam, A. T. M. Gosselink, F. W. A. Verheugt, and K. I. Lie Chronic Atrial Fibrillation: Success of Serial Cardioversion Therapy and Safety of Oral Anticoagulation Arch Intern Med, December 9, 1996; 156(22): 2585 - 2592. [Abstract] [PDF]