European Heart Journal Advance Access published online on June 17, 2009
European Heart Journal, doi:10.1093/eurheartj/ehp235
Early and comprehensive management of atrial fibrillation: executive summary of the proceedings from the 2nd AFNET-EHRA consensus conference ‘research perspectives in AF’
1 Department of Cardiology and Angiology, University Hospital Münster, Albert-Schweitzer-Straße 33, D-48149 Münster, Germany
2 University Hospital Leiden, Leiden, The Netherlands
3 Department of Cardiology, University of Uppsala, Uppsala, Sweden
4 Johns Hopkins University, Baltimore, MD, USA
5 St George's University of London, London, UK
6 Department of Cardiology, Policlinico S. Matteo, Pavia, Italy
7 Hospital Telleras, Madrid, Spain
8 University of Maastricht, Maastricht, The Netherlands
9 University of Duisburg-Essen, Essen, Germany
10 Department of Cardiology, University of Magdeburg, Magdeburg, Germany
11 Johann-Wolfgang Goethe-Universität Frankfurt, Frankfurt, Germany
12 Department of Cardiology, General Hospital St Georg, Hamburg, Germany
13 Haemostasis Thrombosis and Vascular Biology Unit, University Department of Medicine, City Hospital, Birmingham, UK
14 Montreal Heart Institute, Montreal, Canada
15 University of Washington School of Medicine, Seattle, USA
16 Technical University Dresden, Dresden, Germany
17 Ludwigs-Maximilian University of Munich, Munich, Germany
18 University of Crete, Heraklion, Greece
19 Case Western Reserve University, Cleveland, OH, USA
20 University of Hamburg, Hamburg, Germany
Received 16 April 2009; revised 8 May 2009; accepted 18 May 2009 * Corresponding author. Tel: +49 251 8345185, Fax: +49 251 8347617, Email: kirchhp{at}uni-muenster.de
Atrial fibrillation (AF) causes important mortality and morbidity on a population-level. So far, we do not have the means to prevent AF or AF-related complications adequately. Therefore, over 70 experts on atrial fibrillation convened for the 2nd AFNET/EHRA consensus conference to suggest directions for research to improve management of AF patients (Appendix 1). The group defined three main areas in need for research in AF: 1. better understanding of the mechanisms of AF; 2. Improving rhythm control monitoring and management; and 3. comprehensive cardiovascular risk management in AF patients. The group put forward the hypothesis that successful therapy of AF and its associated complications will require comprehensive therapy. This applies e.g. to the "old" debate of "rate versus rhythm control", since rhythm control is generally added to underlying (continued) rate control therapy, but also to the emerging debate of "antiarrhythmic drugs versus catheter ablation", of which both may be needed in most patients to maintain sinus rhythm, but also to therapy of conditions that predispose to AF and contribute to cardiovascular complications such as stroke, cognitive decline, heart failure, and acute coronary syndromes. We call for research initiatives aiming at a better understanding of the different causes of AF and its complications, and at development and validation of mechanism-based therapies. The future of AF therapy may require a combination of management of underlying and concomitant conditions, early and comprehensive rhythm control therapy, adequate control of ventricular rate and cardiac function, and continuous therapy to prevent AF-associated complications (e.g. antithrombotic therapy). The reasons for these suggestions are detailed in this paper.