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J Am Coll Cardiol, 2001; 37:371-378
© 2001 by the American College of Cardiology Foundation
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REVIEW ARTICLE

Epidemiology and natural history of atrial fibrillation: clinical implications

Sumeet S. Chugh, MD, FACC*, Joseph L. Blackshear, MD, FACC{dagger}, Win-Kuang Shen, MD, FACC*, Stephen C. Hammill, MD, FACC* and Bernard J. Gersh, MB, DPhil, ChB, FACC*

* Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA
{dagger} Division of Cardiovascular Diseases, Mayo Clinic Jacksonville, Jacksonville, Florida, USA

Manuscript received March 29, 2000; revised manuscript received August 24, 2000, accepted October 4, 2000.

Reprint requests and correspondence: Dr. Bernard J. Gersh, Mayo Clinic, 200 First Street Southwest, Rochester, Minnesota 55905

With a substantial impact on morbidity and mortality, the growing "epidemic" of atrial fibrillation (AF) intersects with a number of conditions, including aging, thromboembolism, hemorrhage, hypertension and left ventricular dysfunction. Currently, the epidemiology and natural history of AF govern all aspects of its clinical management. The ongoing global investigative efforts toward understanding AF are also driven by epidemiologic findings. New developments, by affecting the natural history of the disease, could eventually alter the nature of decision making in patients with AF. The crucial issue of rate versus rhythm control awaits completion of the AF Follow-up Investigation of Rhythm Management trial. The processes of electrical and structural remodeling that perpetuate AF appear to be reversible. In the era of functional genomics, the molecular basis of this ubiquitous arrhythmia is in the process of being defined. Unraveling the molecular genetics of AF might provide new insights into the structural and electrical phenotypes resulting from genetic mutations and, as such, new approaches to treatment of this arrhythmia at the ion channel and cellular levels. Thus, current adverse trends are superimposed on a background of a rapidly developing knowledge base and potentially exciting new therapeutic options. Consequently, an understanding of the epidemiology and natural history of AF is crucial to the future allocation of resources and the utilization of an expanding range of therapies aimed at reducing the impact of this disease on a changing patient population.

Abbreviations and Acronyms
  AF = atrial fibrillation
  CHF = congestive heart failure
  LV = left ventricle, left ventricular
  SOLVD = Studies Of Left Ventricular Dysfunction
  SPAF = Stroke Prevention in Atrial Fibrillation trial




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