Epidemiology and natural history of atrial fibrillation: Clinical implications

With a substantial impact on morbidity and mortality, the growing "epidemic " of atrial fibrillation (AF) intersects with a number of conditions, inclu ding aging, thromboembolism, hemorrhage, hypertension and left ventricular dysfunction. Currently, the epidemiology and natural history of AF govern a ll aspects of its clinical management. The ongoing global investigative eff orts coward understanding AF are also driven by epidemiologic findings. New developments, by affecting the natural history of the disease, could event ually 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 I nvestigation of Rhythm Management trial. The processes of electrical and st ructural remodeling that perpetuate AF appear to be reversible. In the era of functional genomics, the molecular basis of this ubiquitous arrhythmia i s in the process of being defined. Unraveling the molecular genetics of AF might provide new insights into the structural and electrical phenotypes re sulting from genetic mutations and, as such, new approaches to treatment of this arrhythmia at the ion channel and cellular levels. Thus, current adve rse trends are superimposed on a background of a rapidly developing knowled ge base and potentially exciting new therapeutic options. Consequently, an understanding of the epidemiology and natural history of AF is crucial to t he future allocation of resources and the utilization of an expanding range of therapies aimed at reducing the impact of this disease on a changing pa tient population. (C) 2001 by the American College of Cardiology.