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Atrial fibrillation

Atrial fibrillation (AF) is the most prevalent sustained cardiac arrhythmia, and is associated with a substantial economic burden. This comprehensive collection of articles from Nature Reviews Cardiology and Nature Reviews Disease Primers includes the latest information on the epidemiology, pathophysiology, prevention, and treatment of AF. Identifying the mechanisms underlying AF will result in development of novel therapies, as well as new detection and prevention strategies, thereby improving the quality of life and clinical outcomes of patients with AF. This collection is associated with a PrimeView on AF as well as a Poster and Animation on anticoagulation.

Articles

Atrial fibrillation occurs when cardiac electrical impulses become disordered, leading to a rapid and irregular heartbeat. Lip and colleagues discuss the mechanisms that underlie this common arrhythmia and outline current strategies and potential future developments for its diagnosis and management.

Primer | | Nature Reviews Disease Primers

Differences between women and men with atrial fibrillation have received far less attention in recent years than sex-specific differences in coronary heart disease and stroke. In this Review, Ko et al. discuss sex-specific differences in the incidence, prevalence, risk factors, and pathophysiology of atrial fibrillation, and the clinical presentation and prognosis of patients with this prevalent arrhythmia.

Review Article | | Nature Reviews Cardiology

To bridge the current gap between the known mechanisms of atrial fibrillation (AF) and the clinical management of patients with this arrhythmia, Fabritz and colleagues propose a roadmap to develop a set of clinical markers that reflect the major causes of AF in patients. A new, mechanism-based classification of AF can provide the basis for personalized prevention and management.

Consensus Statement | Open Access | | Nature Reviews Cardiology

Atrial fibrillation (AF) and heart failure (HF) are evolving epidemics with increasing global prevalence. HF is known to promote AF, but how AF exacerbates or even causes HF is uncertain. In this Review, Ling and colleagues present the current understanding of the epidemiology and pathophysiology of AF–HF, and the roles of pharmacological and interventional therapies in the management of patients with this comorbidity.

Review Article | | Nature Reviews Cardiology

Patients with sinus node disease (SND) and an implanted cardiac pacemaker have high prevalence of atrial tachyarrhythmias and atrial fibrillation (AF). In this Review, Boriani and Padeletti describe new developments in pacemaker technology that enable continuous monitoring of the atrial rhythm and allow detection of the burden of AF. These clinical advances could improve guidelines and management of AF and atrial tachyarrhythmias.

Review Article | | Nature Reviews Cardiology

An increasing body of evidence suggests that proteins involved in the inflammatory response are also involved in the pathophysiology of atrial fibrillation (AF). Moreover, AF itself can induce inflammation. In this Review, Hu and colleagues discuss the interplay between inflammation and AF. The authors also highlight potential therapies that might be used to treat inflammation-induced AF.

Review Article | | Nature Reviews Cardiology

Available treatments for atrial fibrillation (AF) often lack sufficient efficacy or have considerable complications, but novel therapies based on the underlying molecular mechanisms of AF can provide useful alternatives. MicroRNAs (miRNAs) regulate gene transcription, and constitute a promising therapeutic approach for the treatment of AF. In this Review article, Luo et al. provide a comprehensive overview of the mechanisms of miRNA action, and explore the available experimental evidence supporting a role for miRNAs as novel therapeutic targets for AF.

Review Article | | Nature Reviews Cardiology

The prevalence of atrial fibrillation (AF) is estimated to increase worldwide, mainly as a consequence of generalized population ageing. Even though the rise in AF prevalence is a global trend, data from Africa, Asia, and South America are limited and might underestimate the true frequency of AF. In this Review, the authors discuss the available epidemiological data on AF and highlight the widespread inadequacy of its treatment.

Review Article | | Nature Reviews Cardiology

The left atrial appendage (LAA) is the main location of thrombus formation in patients with atrial fibrillation. This Review by Romero et al. is focused on the pathophysiology, assessment, and clinical implications of stasis and thrombus formation in the LAA. The advantages and disadvantages of the available imaging modalities for LAA assessment are discussed, and the authors explore the role of cardiac imaging in the therapeutic use of LAA closure devices.

Review Article | | Nature Reviews Cardiology

Asian individuals have a higher risk of stroke associated with atrial fibrillation (AF) than white patients. The use of the vitamin K antagonist warfarin is low in Asian countries, owing to the challenge of controlling anticoagulation and the high-risk of haemorrhage with warfarin in Asians. The non-vitamin K antagonist, oral anticoagulant drugs offer a solution to these challenges. In this article, Sabir et al. discuss the use of these agents in the management of AF in Asian populations.

Review Article | | Nature Reviews Cardiology

Percutaneous transcatheter mechanical occlusion of the left atrial appendage (LAA) is a nonpharmacological treatment option for stroke prevention in patients with atrial fibrillation who cannot receive anticoagulant drugs. In this Review, Cheuk-Man Yu and colleagues present the rationale for LAA occlusion in patients with AF, the available occlusion devices and the clinical evidence for their use, and discuss the role of imaging techniques in device implantation and the management of procedural complications.

Review Article | | Nature Reviews Cardiology

Atrial fibrillation is one of the most common heart arrhythmias. In this Review, Dewire and Calkins discuss the development and role of catheter ablation to electrically isolate the pulmonary veins in patients with paroxysmal, persistent, or longstanding persistent atrial fibrillation. They go on to highlight novel tools that improve the safety, efficacy, and precision of ablation techniques.

Review Article | | Nature Reviews Cardiology