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(Circulation. 2004;109:3089-3095.)
© 2004 American Heart Association, Inc.

Reviews: Clinical Cardiology: New Frontiers

Atrial Fibrillation: A Perspective

Thinking Inside and Outside the Box

D. George Wyse, MD, PhD; Bernard J. Gersh, MBChB, DPhil

From the Department of Cardiac Sciences, University of Calgary and Libin Cardiovascular Institute of Alberta, Calgary, Alberta, Canada (D.G.W.), and Division of Cardiovascular Disease, Mayo Medical Center and Foundation, Rochester, Minn (B.J.G.).

Correspondence to D. George Wyse, MD, PhD, Department of Cardiac Sciences, University of Calgary, Room G009, Health Sciences Center, 3330 Hospital Dr NW, Calgary, Alberta, Canada T2N 4N1. E-mail dgwyse@ucalgary.ca

Key Words: atrial fibrillation • heart failure, congestive • tachyarrhythmias • electrophysiology

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Atrial fibrillation (AF) is a common clinical problem that is increasing in prevalence¹ and is inextricably linked to another burgeoning cardiovascular problem, namely, congestive heart failure.² There is increasing evidence that AF, at least in some population subsets, may be part of a spectrum of atherosclerotic vascular disease, hypertension, inflammation, diastolic dysfunction, and the metabolic syndromes. AF is part of a family of atrial tachyarrhythmias (Figure 1). A panel of experts has recently characterized the definition and position of AF within this group of tachyarrhythmias.³ Nonetheless, this family of tachyarrhythmias is closely interrelated, and the individual tachyarrhythmias often coexist in the same patient. Although the present discussion focuses on AF, many of the points made with regard to AF apply to these other tachyarrhythmias to varying degrees.

View larger version (95K): [in this window] [in a new window]   Figure 1. AF family of tachyarrhythmias. This group of tachyarrhythmias shares much in common, including pathophysiology arising from atrial tissue, often involving critical areas near where veins (pulmonary veins, coronary sinus, vena cava) enter the atria.

Recently, international panels of experts have also created clinical practice guidelines⁴ and perspectives on future research directions⁵ for AF. These documents are a rich source of reference to the vast literature on AF. It is not the intention of the present article to review this literature, and, in particular, it is not intended that the reader will use the present article as a manual for managing AF. However, the perspective is intended to provide a framework for rational thinking about the management of AF.

Inside the Basic Scientist’s Box

A . . . [Full Text of this Article]

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