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  • Primer
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Atrial fibrillation

Nature Reviews Disease Primers volume 2, Article number: 16016 (2016) Cite this article

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Abstract

Atrial fibrillation (AF) is the most common sustained cardiac rhythm disorder, and increases in prevalence with increasing age and the number of cardiovascular comorbidities. AF is characterized by a rapid and irregular heartbeat that can be asymptomatic or lead to symptoms such as palpitations, dyspnoea and dizziness. The condition can also be associated with serious complications, including an increased risk of stroke. Important recent developments in the clinical epidemiology and management of AF have informed our approach to this arrhythmia. This Primer provides a comprehensive overview of AF, including its epidemiology, mechanisms and pathophysiology, diagnosis, screening, prevention and management. Management strategies, including stroke prevention, rate control and rhythm control, are considered. We also address quality of life issues and provide an outlook on future developments and ongoing clinical trials in managing this common arrhythmia.

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Figure 1: Electrical conduction during sinus rhythm and atrial fibrillation.
Figure 2: Mechanisms that can maintain atrial fibrillation.
Figure 3: Afterdepolarization-mediated ectopic activity.
Figure 4: Re-entry and models of arrhythmia development.
Figure 5: Typical electrocardiograms in normal sinus rhythm and in atrial fibrillation and flutter.
Figure 6: Risk stratification and decision making in thromboprophylaxis.
Figure 7: Using the SAMe-TT2R2 score to aid decision making between a non-vitamin K antagonist oral anticoagulant and a vitamin K antagonist.
Figure 8: Selection of oral anticoagulant drugs.
Figure 9: Management of atrial fibrillation.
Figure 10: Atrial fibrillation ablation.

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References

  1. Lip, G. Y., Brechin, C. M. & Lane, D. A. The global burden of atrial fibrillation and stroke: a systematic review of the epidemiology of atrial fibrillation in regions outside North America and Europe. Chest 142, 1489–1498 (2012). An important systematic review of the global burden of AF.

    Article  PubMed  Google Scholar 

  2. Lloyd-Jones, D. M. et al. Lifetime risk for development of atrial fibrillation: the Framingham Heart Study. Circulation 110, 1042–1046 (2004).

    Article  PubMed  Google Scholar 

  3. Heeringa, J. et al. Prevalence, incidence and lifetime risk of atrial fibrillation: the Rotterdam study. Eur. Heart J. 27, 949–953 (2006).

    Article  PubMed  Google Scholar 

  4. Chugh, S. S. et al. Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study. Circulation 129, 837–847 (2014).

    Article  PubMed  Google Scholar 

  5. Colilla, S. et al. Estimates of current and future incidence and prevalence of atrial fibrillation in the U.S. adult population. Am. J. Cardiol. 112, 1142–1147 (2013).

    Article  PubMed  Google Scholar 

  6. Krijthe, B. P. et al. Projections on the number of individuals with atrial fibrillation in the European Union, from 2000 to 2060. Eur. Heart J. 34, 2746–2751 (2013). A study on the probable burden of AF in Europe.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Kaushal, S. S., DasGupta, D. J., Prashar, B. S. & Bhardwaj, A. K. Electrocardiographic manifestations of healthy residents of a tribal Himalayan village. J. Assoc. Physicians India 43, 15–16 (1995).

    CAS  PubMed  Google Scholar 

  8. Go, A. S. et al. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) study. JAMA 285, 2370–2375 (2001).

    Article  CAS  PubMed  Google Scholar 

  9. Sturm, J. W., Davis, S. M., O’Sullivan, J. G., Vedadhaghi, M. E. & Donnan, G. A. The Avoid Stroke as Soon as Possible (ASAP) general practice stroke audit. Med. J. Aust. 176, 312–316 (2002).

    PubMed  Google Scholar 

  10. Ball, J., Carrington, M. J., McMurray, J. J. & Stewart, S. Atrial fibrillation: profile and burden of an evolving epidemic in the 21st century. Int. J. Cardiol. 167, 1807–1824 (2013).

    Article  PubMed  Google Scholar 

  11. Hernandez, M. B., Asher, C. R., Hernandez, A. V. & Novaro, G. M. African American race and prevalence of atrial fibrillation: a meta-analysis. Cardiol. Res. Pract. 2012, 275624 (2012).

    Article  PubMed  PubMed Central  Google Scholar 

  12. Dewland, T. A., Olgin, J. E., Vittinghoff, E. & Marcus, G. M. Incident atrial fibrillation among Asians, Hispanics, blacks, and whites. Circulation 128, 2470–2477 (2013).

    Article  PubMed  Google Scholar 

  13. Alonso, A. et al. Incidence of atrial fibrillation in whites and African-Americans: the Atherosclerosis Risk in Communities (ARIC) study. Am. Heart J. 158, 111–117 (2009).

    Article  PubMed  PubMed Central  Google Scholar 

  14. Lip, G. Y. et al. Atrial fibrillation amongst the Indo-Asian general practice population. West Birmingham Atrial Fibrillation Project. Int. J. Cardiol. 65, 187–192 (1998).

    Article  CAS  PubMed  Google Scholar 

  15. Rodriguez, C. J. et al. Atrial fibrillation incidence and risk factors in relation to race-ethnicity and the population attributable fraction of atrial fibrillation risk factors: the Multi-Ethnic Study of Atherosclerosis. Ann. Epidemiol. 25, 71–76.e1 (2015).

    Article  CAS  PubMed  Google Scholar 

  16. Rahman, F., Kwan, G. F. & Benjamin, E. J. Global epidemiology of atrial fibrillation. Nat. Rev. Cardiol. 11, 639–654 (2014).

    Article  PubMed  Google Scholar 

  17. Oldgren, J. et al. Variations in cause and management of atrial fibrillation in a prospective registry of 15,400 emergency department patients in 46 countries: the RE-LY Atrial Fibrillation Registry. Circulation 129, 1568–1576 (2014). A contemporary registry of AF management.

    Article  PubMed  Google Scholar 

  18. Iung, B. & Vahanian, A. Epidemiology of valvular heart disease in the adult. Nat. Rev. Cardiol. 8, 162–172 (2011).

    Article  PubMed  Google Scholar 

  19. Gladstone, D. J. et al. Atrial fibrillation in patients with cryptogenic stroke. N. Engl. J. Med. 370, 2467–2477 (2014).

    Article  CAS  PubMed  Google Scholar 

  20. Wolf, P. A., Abbott, R. D. & Kannel, W. B. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke 22, 983–988 (1991).

    Article  CAS  PubMed  Google Scholar 

  21. Wang, T. J. et al. Temporal relations of atrial fibrillation and congestive heart failure and their joint influence on mortality: the Framingham Heart Study. Circulation 107, 2920–2925 (2003).

    Article  PubMed  Google Scholar 

  22. Kalantarian, S., Stern, T. A., Mansour, M. & Ruskin, J. N. Cognitive impairment associated with atrial fibrillation: a meta-analysis. Ann. Intern. Med. 158, 338–346 (2013).

    Article  PubMed  PubMed Central  Google Scholar 

  23. Benjamin, E. J. et al. Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. Circulation 98, 946–952 (1998).

    Article  CAS  PubMed  Google Scholar 

  24. Schnabel, R. B. et al. Development of a risk score for atrial fibrillation (Framingham Heart Study): a community-based cohort study. Lancet 373, 739–745 (2009). The risk score derived from the Framingham Study for predicting the development of AF.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Alonso, A. et al. Simple risk model predicts incidence of atrial fibrillation in a racially and geographically diverse population: the CHARGE-AF consortium. J. Am. Heart Assoc. 2, e000102 (2013).

    Article  PubMed  PubMed Central  Google Scholar 

  26. Haïssaguerre, M. et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N. Engl. J. Med. 339, 659–666 (1998). The principal paper showing pulmonary vein foci as a source of paroxysmal AF.

    Article  PubMed  Google Scholar 

  27. Lin, W.-S. et al. Catheter ablation of paroxysmal atrial fibrillation initiated by non-pulmonary vein ectopy. Circulation 107, 3176–3183 (2003).

    Article  PubMed  Google Scholar 

  28. Nattel, S. New ideas about atrial fibrillation 50 years on. Nature 415, 219–226 (2002).

    Article  CAS  PubMed  Google Scholar 

  29. Wakili, R., Voigt, N., Kääb, S., Dobrev, D. & Nattel, S. Recent advances in the molecular pathophysiology of atrial fibrillation. J. Clin. Invest. 121, 2955–2968 (2011).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Heijman, J., Voigt, N., Nattel, S. & Dobrev, D. Cellular and molecular electrophysiology of atrial fibrillation initiation, maintenance, and progression. Circ. Res. 114, 1483–1499 (2014). A comprehensive overview of AF electrophysiology.

    Article  CAS  PubMed  Google Scholar 

  31. Yeh, Y.-H. et al. Calcium-handling abnormalities underlying atrial arrhythmogenesis and contractile dysfunction in dogs with congestive heart failure. Circ. Arrhythm. Electrophysiol. 1, 93–102 (2008).

    Article  CAS  PubMed  Google Scholar 

  32. Voigt, N. et al. Enhanced sarcoplasmic reticulum Ca2+ leak and increased Na+–Ca2+ exchanger function underlie delayed afterdepolarizations in patients with chronic atrial fibrillation. Circulation 125, 2059–2070 (2012).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Voigt, N. et al. Cellular and molecular mechanisms of atrial arrhythmogenesis in patients with paroxysmal atrial fibrillation. Circulation 129, 145–156 (2014).

    Article  CAS  PubMed  Google Scholar 

  34. Chen, P.-S., Chen, L. S., Fishbein, M. C., Lin, S.-F. & Nattel, S. Role of the autonomic nervous system in atrial fibrillation: pathophysiology and therapy. Circ. Res. 114, 1500–1515 (2014).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Burashnikov, A. & Antzelevitch, C. Reinduction of atrial fibrillation immediately after termination of the arrhythmia is mediated by late phase 3 early afterdepolarization-induced triggered activity. Circulation 107, 2355–2360 (2003).

    Article  PubMed  Google Scholar 

  36. Patterson, E., Po, S. S., Scherlag, B. J. & Lazzara, R. Triggered firing in pulmonary veins initiated by in vitro autonomic nerve stimulation. Heart Rhythm 2, 624–631 (2005).

    Article  PubMed  Google Scholar 

  37. Allessie, M. A., Bonke, F. I. & Schopman, F. J. Circus movement in rabbit atrial muscle as a mechanism of tachycardia. III. The ‘leading circle’ concept: a new model of circus movement in cardiac tissue without the involvement of an anatomical obstacle. Circ. Res. 41, 9–18 (1977).

    Article  CAS  PubMed  Google Scholar 

  38. Comtois, P., Kneller, J. & Nattel, S. Of circles and spirals: bridging the gap between the leading circle and spiral wave concepts of cardiac reentry. Europace 7 (Suppl. 2), 10–20 (2005).

    Article  PubMed  Google Scholar 

  39. Kneller, J. et al. Mechanisms of atrial fibrillation termination by pure sodium channel blockade in an ionically-realistic mathematical model. Circ. Res. 96, e35–e47 (2005).

    CAS  PubMed  Google Scholar 

  40. Narayan, S. M. et al. Treatment of atrial fibrillation by the ablation of localized sources: CONFIRM (conventional ablation for atrial fibrillation with or without focal impulse and rotor modulation) trial. J. Am. Coll. Cardiol. 60, 628–636 (2012).

    Article  PubMed  PubMed Central  Google Scholar 

  41. Haissaguerre, M. et al. Driver domains in persistent atrial fibrillation. Circulation 130, 530–538 (2014).

    Article  PubMed  Google Scholar 

  42. Calvo, C. J., Deo, M., Zlochiver, S., Millet, J. & Berenfeld, O. Attraction of rotors to the pulmonary veins in paroxysmal atrial fibrillation: a modeling study. Biophys. J. 106, 1811–1821 (2014).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Ehrlich, J. R. et al. Cellular electrophysiology of canine pulmonary vein cardiomyocytes: action potential and ionic current properties. J. Physiol. 551, 801–813 (2003).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Nattel, S. Paroxysmal atrial fibrillation and pulmonary veins: relationships between clinical forms and automatic versus re-entrant mechanisms. Can. J. Cardiol. 29, 1147–1149 (2013).

    Article  PubMed  Google Scholar 

  45. Li, D., Fareh, S., Leung, T. K. & Nattel, S. Promotion of atrial fibrillation by heart failure in dogs: atrial remodeling of a different sort. Circulation 100, 87–95 (1999).

    Article  CAS  PubMed  Google Scholar 

  46. Hansen, B. J. et al. Atrial fibrillation driven by micro-anatomic intramural re-entry revealed by simultaneous sub-epicardial and sub-endocardial optical mapping in explanted human hearts. Eur. Heart J. 36, 2390–2401 (2015).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Iwasaki, Y., Nishida, K., Kato, T. & Nattel, S. Atrial fibrillation pathophysiology: implications for management. Circulation 124, 2264–2274 (2011).

    Article  CAS  PubMed  Google Scholar 

  48. Nishida, K., Datino, T., Macle, L. & Nattel, S. Atrial fibrillation ablation: translating basic mechanistic insights to the patient. J. Am. Coll. Cardiol. 64, 823–831 (2014).

    Article  PubMed  Google Scholar 

  49. Wijffels, M. C., Kirchhof, C. J., Dorland, R. & Allessie, M. A. Atrial fibrillation begets atrial fibrillation. A study in awake chronically instrumented goats. Circulation 92, 1954–1968 (1995). A classic paper showing how ‘AF begets AF’ in relation to arrhythmia perpetuation.

    Article  CAS  PubMed  Google Scholar 

  50. Yue, L. et al. Ionic remodeling underlying action potential changes in a canine model of atrial fibrillation. Circ. Res. 81, 512–525 (1997).

    Article  CAS  PubMed  Google Scholar 

  51. Qi, X. Y. et al. Cellular signaling underlying atrial tachycardia remodeling of L-type calcium current. Circ. Res. 103, 845–854 (2008).

    Article  CAS  PubMed  Google Scholar 

  52. Pandit, S. V. et al. Ionic determinants of functional reentry in a 2D model of human atrial cells during simulated chronic atrial fibrillation. Biophys. J. 88, 3806–3821 (2005).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  53. Luo, X. et al. MicroRNA-26 governs profibrillatory inward-rectifier potassium current changes in atrial fibrillation. J. Clin. Invest. 123, 1939–1951 (2013).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  54. Igarashi, T. et al. Connexin gene transfer preserves conduction velocity and prevents atrial fibrillation. Circulation 125, 216–225 (2012).

    Article  CAS  PubMed  Google Scholar 

  55. Bikou, O. et al. Connexin 43 gene therapy prevents persistent atrial fibrillation in a porcine model. Cardiovasc. Res. 92, 218–225 (2011).

    Article  CAS  PubMed  Google Scholar 

  56. Kato, T., Iwasaki, Y. & Nattel, S. Connexins and atrial fibrillation: filling in the gaps. Circulation 125, 203–206 (2012).

    Article  PubMed  Google Scholar 

  57. Burstein, B., Qi, X.-Y., Yeh, Y.-H., Calderone, A. & Nattel, S. Atrial cardiomyocyte tachycardia alters cardiac fibroblast function: a novel consideration in atrial remodeling. Cardiovasc. Res. 76, 442–452 (2007).

    Article  CAS  PubMed  Google Scholar 

  58. Martins, R. P. et al. Dominant frequency increase rate predicts transition from paroxysmal to long-term persistent atrial fibrillation. Circulation 129, 1472–1482 (2014).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  59. Andrade, J., Khairy, P., Dobrev, D. & Nattel, S. The clinical profile and pathophysiology of atrial fibrillation: relationships among clinical features, epidemiology, and mechanisms. Circ. Res. 114, 1453–1468 (2014).

    Article  CAS  PubMed  Google Scholar 

  60. Verheule, S. et al. Alterations in atrial electrophysiology and tissue structure in a canine model of chronic atrial dilatation due to mitral regurgitation. Circulation 107, 2615–2622 (2003).

    Article  PubMed  PubMed Central  Google Scholar 

  61. Sinno, H. et al. Atrial ischemia promotes atrial fibrillation in dogs. Circulation 107, 1930–1936 (2003).

    Article  PubMed  Google Scholar 

  62. Nishida, K. et al. Mechanisms of atrial tachyarrhythmias associated with coronary artery occlusion in a chronic canine model. Circulation 123, 137–146 (2011).

    Article  CAS  PubMed  Google Scholar 

  63. Lau, D. H. et al. Hypertension and atrial fibrillation: evidence of progressive atrial remodeling with electrostructural correlate in a conscious chronically instrumented ovine model. Heart Rhythm 7, 1282–1290 (2010).

    Article  PubMed  Google Scholar 

  64. Abed, H. S. et al. Obesity results in progressive atrial structural and electrical remodeling: implications for atrial fibrillation. Heart Rhythm 10, 90–100 (2013).

    Article  PubMed  Google Scholar 

  65. Iwasaki, Y.-K. et al. Atrial fibrillation promotion with long-term repetitive obstructive sleep apnea in a rat model. J. Am. Coll. Cardiol. 64, 2013–2023 (2014).

    Article  PubMed  Google Scholar 

  66. Pathak, R. K. et al. Long-term effect of goal directed weight management in an atrial fibrillation cohort: a long-term follow-up study (LEGACY study). J. Am. Coll. Cardiol. 65, 2159–2169 (2015).

    Article  PubMed  Google Scholar 

  67. Fein, A. S. et al. Treatment of obstructive sleep apnea reduces the risk of atrial fibrillation recurrence after catheter ablation. J. Am. Coll. Cardiol. 62, 300–305 (2013).

    Article  PubMed  Google Scholar 

  68. Nattel, S. et al. New directions in cardiac arrhythmia management: present challenges and future solutions. Can. J. Cardiol. 30, S420–S430 (2014).

    Article  PubMed  Google Scholar 

  69. Savelieva, I. & Camm, A. J. Clinical relevance of silent atrial fibrillation: prevalence, prognosis, quality of life, and management. J. Interv. Card. Electrophysiol. 4, 369–382 (2000).

    Article  CAS  PubMed  Google Scholar 

  70. Lau, J. K. et al. iPhone ECG application for community screening to detect silent atrial fibrillation: a novel technology to prevent stroke. Int. J. Cardiol. 165, 193–194 (2013).

    Article  PubMed  Google Scholar 

  71. January, C. T. et al. 2014 AHA/ACC/HRS Guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society. J. Am. Coll. Cardiol. 64, e1–e76 (2014).

    Article  PubMed  Google Scholar 

  72. Friberg, L. et al. High prevalence of atrial fibrillation among patients with ischemic stroke. Stroke 45, 2599–2605 (2014).

    Article  CAS  PubMed  Google Scholar 

  73. Leyden, J. M. et al. Adelaide stroke incidence study: declining stroke rates but many preventable cardioembolic strokes. Stroke 44, 1226–1231 (2013).

    Article  PubMed  Google Scholar 

  74. Camm, A. J. et al. 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association. Eur. Heart J. 33, 2719–2747 (2012). European guidelines on AF.

    Article  PubMed  Google Scholar 

  75. Hobbs, F. D. R. et al. A randomised controlled trial and cost-effectiveness study of systematic screening (targeted and total population screening) versus routine practice for the detection of atrial fibrillation in people aged 65 and over. The SAFE study. Health Technol. Assess. 9, http://dx.doi.org/10.3310/hta9400 (2005). The only large randomized trial of opportunistic versus systematic screening for AF.

  76. Wiesel, J., Arbesfeld, B. & Schechter, D. Comparison of the Microlife blood pressure monitor with the Omron blood pressure monitor for detecting atrial fibrillation. Am. J. Cardiol. 114, 1046–1048 (2014).

    Article  PubMed  Google Scholar 

  77. McManus, D. D. et al. A novel application for the detection of an irregular pulse using an iPhone 4S in patients with atrial fibrillation. Heart Rhythm 10, 315–319 (2013).

    Article  PubMed  Google Scholar 

  78. Engdahl, J., Andersson, L., Mirskaya, M. & Rosenqvist, M. Stepwise screening of atrial fibrillation in a 75-year-old population: implications for stroke prevention. Circulation 127, 930–937 (2013).

    Article  PubMed  Google Scholar 

  79. Lowres, N. et al. Feasibility and cost-effectiveness of stroke prevention through community screening for atrial fibrillation using iPhone ECG in pharmacies. The SEARCH-AF study. Thromb. Haemost. 111, 1167–1176 (2014). An assessment of AF screening using iPhone technology.

    Article  CAS  PubMed  Google Scholar 

  80. Tieleman, R. G. et al. Validation and clinical use of a novel diagnostic device for screening of atrial fibrillation. Europace 16, 1291–1295 (2014).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  81. Lowres, N., Neubeck, L., Redfern, J. & Freedman, S. B. Screening to identify unknown atrial fibrillation. A systematic review. Thromb. Haemost. 110, 213–222 (2013). A systematic review of screening for AF.

    Article  CAS  PubMed  Google Scholar 

  82. Martinez, C., Katholing, A. & Freedman, S. B. Adverse prognosis of incidentally detected ambulatory atrial fibrillation. A cohort study. Thromb. Haemost. 112, 276–286 (2014).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  83. Kirchhof, P. et al. A roadmap to improve the quality of atrial fibrillation management: proceedings from the fifth Atrial Fibrillation Network/European Heart Rhythm Association consensus conference. Europace 18, 37–50 (2016).

    Article  PubMed  Google Scholar 

  84. Ben Freedman, S. & Lowres, N. Asymptomatic atrial fibrillation: the case for screening to prevent stroke. JAMA 314, 1911–1912 (2015).

    Article  CAS  PubMed  Google Scholar 

  85. Tondo, C. et al. Rhythm-symptom correlation in patients on continuous monitoring after catheter ablation of atrial fibrillation. J. Cardiovasc. Electrophysiol. 25, 154–160 (2014).

    Article  CAS  PubMed  Google Scholar 

  86. Manganiello, S. et al. Symptomatic and asymptomatic long-term recurrences following transcatheter atrial fibrillation ablation. Pacing Clin. Electrophysiol. 37, 697–702 (2014).

    Article  PubMed  Google Scholar 

  87. Lowres, N. et al. Self-monitoring for atrial fibrillation recurrence in the discharge period post-cardiac surgery using an iPhone electrocardiogram. Eur. J. Cardiothorac. Surg. http://dx.doi.org/10.1093/ejcts/ezv486 (2016).

  88. Kishore, A. et al. Detection of atrial fibrillation after ischemic stroke or transient ischemic attack: a systematic review and meta-analysis. Stroke 45, 520–526 (2014). A systematic review of AF detection post-stroke.

    Article  CAS  PubMed  Google Scholar 

  89. Sanna, T. et al. Cryptogenic stroke and underlying atrial fibrillation. N. Engl. J. Med. 370, 2478–2486 (2014).

    Article  CAS  PubMed  Google Scholar 

  90. Kamel, H. Heart-rhythm monitoring for evaluation of cryptogenic stroke. N. Engl. J. Med. 370, 2532–2533 (2014).

    Article  CAS  PubMed  Google Scholar 

  91. Mittal, S. et al. Frequency, duration, and predictors of newly-diagnosed atrial fibrillation following dual-chamber pacemaker implantation in patients without a previous history of atrial fibrillation. Am. J. Cardiol. 102, 450–453 (2008).

    Article  PubMed  Google Scholar 

  92. Healey, J. S. et al. Subclinical atrial fibrillation and the risk of stroke. N. Engl. J. Med. 366, 120–129 (2012). An important paper on subclinical AF detected by devices.

    Article  CAS  PubMed  Google Scholar 

  93. Boriani, G. et al. Device-detected atrial fibrillation and risk for stroke: an analysis of >10,000 patients from the SOS AF project (Stroke preventiOn Strategies based on Atrial Fibrillation information from implanted devices). Eur. Heart J. 35, 508–516 (2014).

    Article  PubMed  Google Scholar 

  94. Kaufman, E. S. et al. Positive predictive value of device-detected atrial high-rate episodes at different rates and durations: an analysis from ASSERT. Heart Rhythm 9, 1241–1246 (2012).

    Article  PubMed  Google Scholar 

  95. DeCicco, A. E., Finkel, J. B., Greenspon, A. J. & Frisch, D. R. Clinical significance of atrial fibrillation detected by cardiac implantable electronic devices. Heart Rhythm 11, 719–724 (2014).

    Article  PubMed  Google Scholar 

  96. Chen-Scarabelli, C., Scarabelli, T. M., Ellenbogen, K. A. & Halperin, J. L. Device-detected atrial fibrillation: what to do with asymptomatic patients? J. Am. Coll. Cardiol. 65, 281–294 (2015).

    Article  PubMed  Google Scholar 

  97. Turakhia, M. P. et al. Atrial fibrillation burden and short-term risk of stroke: case-crossover analysis of continuously recorded heart rhythm from cardiac electronic implanted devices. Circ. Arrhythm. Electrophysiol. 8, 1040–1047 (2015).

    Article  PubMed  Google Scholar 

  98. Brambatti, M. et al. Temporal relationship between subclinical atrial fibrillation and embolic events. Circulation 129, 2094–2099 (2014).

    Article  PubMed  Google Scholar 

  99. Zuhlke, L. et al. Characteristics, complications, and gaps in evidence-based interventions in rheumatic heart disease: the Global Rheumatic Heart Disease Registry (the REMEDY study). Eur. Heart J. 36, 1115–1122 (2015).

    Google Scholar 

  100. De Dassel, J. L., Ralph, A. P. & Carapetis, J. R. Controlling acute rheumatic fever and rheumatic heart disease in developing countries: are we getting closer? Curr. Opin. Pediatr. 27, 116–123 (2015).

    Article  CAS  PubMed  Google Scholar 

  101. Watkins, D. A., Mvundura, M., Nordet, P. & Mayosi, B. M. A cost-effectiveness analysis of a program to control rheumatic fever and rheumatic heart disease in Pinar del Rio, Cuba. PLoS ONE 10, e0121363 (2015).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  102. Wanahita, N. et al. Atrial fibrillation and obesity: results of a meta-analysis. Am. Heart J. 155, 310–315 (2008).

    Article  PubMed  Google Scholar 

  103. Wang, T. J. et al. Obesity and the risk of new-onset atrial fibrillation. JAMA 292, 2471–2477 (2004).

    Article  CAS  PubMed  Google Scholar 

  104. Tedrow, U. B. et al. The long- and short-term impact of elevated body mass index on the risk of new atrial fibrillation: the WHS (Women's Health Study). J. Am. Coll. Cardiol. 55, 2319–2327 (2010).

    Article  PubMed  PubMed Central  Google Scholar 

  105. Andersen, K. et al. Risk of arrhythmias in 52 755 long-distance cross-country skiers: a cohort study. Eur. Heart J. 34, 3624–3631 (2013).

    Article  PubMed  Google Scholar 

  106. La Gerche, A. & Schmied, C. M. Atrial fibrillation in athletes and the interplay between exercise and health. Eur. Heart J. 34, 3599–3602 (2013).

    Article  PubMed  Google Scholar 

  107. Mozaffarian, D., Furberg, C. D., Psaty, B. M. & Siscovick, D. Physical activity and incidence of atrial fibrillation in older adults: the cardiovascular health study. Circulation 118, 800–807 (2008).

    Article  PubMed  PubMed Central  Google Scholar 

  108. Larsson, S. C., Drca, N. & Wolk, A. Alcohol consumption and risk of atrial fibrillation: a prospective study and dose-response meta-analysis. J. Am. Coll. Cardiol. 64, 281–289 (2014).

    Article  CAS  PubMed  Google Scholar 

  109. Samokhvalov, A. V., Irving, H. M. & Rehm, J. Alcohol consumption as a risk factor for atrial fibrillation: a systematic review and meta-analysis. Eur. J. Cardiovasc. Prev. Rehabil. 17, 706–712 (2010).

    Article  PubMed  PubMed Central  Google Scholar 

  110. Holmqvist, F. et al. Obstructive sleep apnea and atrial fibrillation: findings from ORBIT-AF. J. Am. Coll. Cardiol. Abstr. 63, A292 (2014).

    Article  Google Scholar 

  111. Stevenson, I. H. et al. Prevalence of sleep disordered breathing in paroxysmal and persistent atrial fibrillation patients with normal left ventricular function. Eur. Heart J. 29, 1662–1669 (2008).

    Article  PubMed  Google Scholar 

  112. Kanagala, R. et al. Obstructive sleep apnea and the recurrence of atrial fibrillation. Circulation 107, 2589–2594 (2003).

    Article  PubMed  Google Scholar 

  113. Russo, V. et al. Severe obesity and P-wave dispersion: the effect of surgically induced weight loss. Obes. Surg. 18, 90–96 (2008).

    Article  PubMed  Google Scholar 

  114. Abed, H. S. et al. Effect of weight reduction and cardiometabolic risk factor management on symptom burden and severity in patients with atrial fibrillation: a randomized clinical trial. JAMA 310, 2050–2060 (2013).

    Article  CAS  PubMed  Google Scholar 

  115. Reinhart, K., Baker, W. L. & Siv, M. L. Beyond the guidelines: new and novel agents for the prevention of atrial fibrillation after cardiothoracic surgery. J. Cardiovasc. Pharmacol. Ther. 16, 5–13 (2011).

    Article  PubMed  Google Scholar 

  116. Fang, W. T., Li, H. J., Zhang, H. & Jiang, S. The role of statin therapy in the prevention of atrial fibrillation: a meta-analysis of randomized controlled trials. Br. J. Clin. Pharmacol. 74, 744–756 (2012).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  117. Imazio, M. et al. Colchicine for prevention of postpericardiotomy syndrome and postoperative atrial fibrillation: the COPPS-2 randomized clinical trial. JAMA 312, 1016–1023 (2014).

    Article  CAS  PubMed  Google Scholar 

  118. Johnston, K. & Stephens, S. Effect of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers on risk of atrial fibrillation before coronary artery bypass grafting. Ann. Pharmacother. 46, 1239–1244 (2012).

    Article  PubMed  Google Scholar 

  119. Hung, C. Y. et al. Efficacy of different statins for primary prevention of atrial fibrillation in male and female patients: a nationwide population-based cohort study. Int. J. Cardiol. 168, 4367–4369 (2013).

    Article  PubMed  Google Scholar 

  120. Watson, T., Shantsila, E. & Lip, G. Y. Mechanisms of thrombogenesis in atrial fibrillation: Virchow's triad revisited. Lancet 373, 155–166 (2009). An overview of pathogenesis of thrombosis in AF.

    Article  CAS  PubMed  Google Scholar 

  121. Lip, G. Y. H. & Lane, D. A. Stroke prevention in atrial fibrillation: a systematic review. JAMA 313, 1950–1962 (2015). A contemporary review of stroke prevention in patients with AF.

    Article  PubMed  Google Scholar 

  122. Lin, H. J. et al. Stroke severity in atrial fibrillation. The Framingham Study. Stroke 27, 1760–1764 (1996).

    Article  CAS  PubMed  Google Scholar 

  123. Hart, R. G., Pearce, L. A. & Aguilar, M. I. Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Ann. Intern. Med. 146, 857–867 (2007). A meta-analysis of trials for stroke prevention in patients with AF.

    Article  PubMed  Google Scholar 

  124. Lip, G. Y. The role of aspirin for stroke prevention in atrial fibrillation. Nat. Rev. Cardiol. 8, 602–606 (2011). An overview of the role of aspirin in stroke prevention for AF.

    Article  CAS  PubMed  Google Scholar 

  125. Pisters, R., Lane, D. A., Marin, F., Camm, A. J. & Lip, G. Y. Stroke and thromboembolism in atrial fibrillation. Circ. J. 76, 2289–2304 (2012).

    Article  PubMed  Google Scholar 

  126. Gage, B. F. et al. Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation. JAMA 285, 2864–2870 (2001).

    Article  CAS  PubMed  Google Scholar 

  127. Karthikeyan, G. & Eikelboom, J. W. The CHADS2 score for stroke risk stratification in atrial fibrillation — friend or foe? Thromb. Haemost. 104, 45–48 (2010).

    Article  CAS  PubMed  Google Scholar 

  128. Lip, G. Y., Nieuwlaat, R., Pisters, R., Lane, D. A. & Crijns, H. J. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation. Chest 137, 263–272 (2010). The original paper validating the CHA2DS2-VASC score.

    Article  PubMed  Google Scholar 

  129. Olesen, J. B. et al. Validation of risk stratification schemes for predicting stroke and thromboembolism in patients with atrial fibrillation: nationwide cohort study. BMJ 342, d124 (2011).

    Article  PubMed  PubMed Central  Google Scholar 

  130. Olesen, J. B., Torp-Pedersen, C., Hansen, M. L. & Lip, G. Y. The value of the CHA2DS2-VASc score for refining stroke risk stratification in patients with atrial fibrillation with a CHADS2 score 0–1: a nationwide cohort study. Thromb. Haemost. 107, 1172–1179 (2012).

    Article  CAS  PubMed  Google Scholar 

  131. Chao, T.-F. et al. Comparisons of CHADS2 and CHA2DS2-VASc scores for stroke risk stratification in atrial fibrillation: which scoring system should be used for Asians? Heart Rhythm 13, 46–53 (2016).

    Article  PubMed  Google Scholar 

  132. Siu, C.-W., Lip, G. Y. H., Lam, K.-F. & Tse, H.-F. Risk of stroke and intracranial hemorrhage in 9727 Chinese with atrial fibrillation in Hong Kong. Heart Rhythm 11, 1401–1408 (2014).

    Article  PubMed  Google Scholar 

  133. Apostolakis, S. et al. Assessment of stroke risk in Middle Eastern patients with atrial fibrillation: the Gulf SAFE registry. Int. J. Cardiol. 168, 1644–1646 (2013).

    Article  CAS  PubMed  Google Scholar 

  134. Chao, T.-F. et al. Age threshold for increased stroke risk among patients with atrial fibrillation. J. Am. Coll. Cardiol. 66, 1339–1347 (2015).

    Article  PubMed  Google Scholar 

  135. Lip, G. Y. & Lane, D. A. Modern management of atrial fibrillation requires initial identification of ‘low-risk’ patients using the CHA2DS2-VASc score, and not focusing on ‘high-risk’ prediction. Circ. J. 78, 1843–1845 (2014).

    Article  PubMed  Google Scholar 

  136. Nielsen, P. B. & Chao, T. F. The risks of risk scores for stroke risk assessment in atrial fibrillation. Thromb. Haemost. 113, 1170–1173 (2015).

    Article  PubMed  Google Scholar 

  137. Chao, T. F. et al. Should atrial fibrillation patients with 1 additional risk factor of the CHA2DS2-VASc score (beyond sex) receive oral anticoagulation? J. Am. Coll. Cardiol. 65, 635–642 (2015).

    Article  PubMed  Google Scholar 

  138. Lip, G. Y., Skjoth, F., Rasmussen, L. H. & Larsen, T. B. Oral anticoagulation, aspirin, or no therapy in patients with nonvalvular AF with 0 or 1 stroke risk factor based on the CHADS-VASc score. J. Am. Coll. Cardiol. 65, 1385–1394 (2015).

    Article  CAS  PubMed  Google Scholar 

  139. Lip, G. Y. H., Skjøth, F., Rasmussen, L. H., Nielsen, P. B. & Larsen, T. B. Net clinical benefit for oral anticoagulation, aspirin, or no therapy in nonvalvular atrial fibrillation patients with one additional risk factor of the CHA2DS2- VASc score (beyond sex). J. Am. Coll. Cardiol. 66, 488–490 (2015).

    Article  PubMed  Google Scholar 

  140. Lip, G. Y. H., Skjøth, F., Nielsen, P. B. & Larsen, T. B. Non-valvular atrial fibrillation patients with none or one additional risk factor of the CHA2DS2-VASc score. A comprehensive net clinical benefit analysis for warfarin, aspirin, or no therapy. Thromb. Haemost. 114, 826–834 (2015).

    Article  PubMed  Google Scholar 

  141. Ntaios, G. et al. Leukoaraiosis and stroke recurrence risk in patients with and without atrial fibrillation. Neurology 84, 1213–1219 (2015).

    Article  PubMed  Google Scholar 

  142. Charidimou, A. et al. The Clinical Relevance of Microbleeds in Stroke study (CROMIS-2): rationale, design, and methods. Int. J. Stroke 10 (Suppl. A), 155–161 (2015).

    Article  PubMed  Google Scholar 

  143. Apostolakis, S., Sullivan, R. M., Olshansky, B. & Lip, G. Y. Factors affecting quality of anticoagulation control among patients with atrial fibrillation on warfarin: the SAMe-TT2R2 score. Chest 144, 1555–1563 (2013). The original paper describing the SAMe-TT2R2 score.

    Article  CAS  PubMed  Google Scholar 

  144. Proietti, M. & Lip, G. Y. H. Simple decision making between a vitamin K antagonist and non-vitamin K antagonist oral anticoagulant (NOACs): using the SAMe-TT2R2 score. Eur. Heart J. Cardiovasc. Pharmacother. 1, 150–152 (2015).

    Article  PubMed  Google Scholar 

  145. Lip, G. Y., Haguenoer, K., Saint-Etienne, C. & Fauchier, L. Relationship of the SAMe-TT2R2 score to poor-quality anticoagulation, stroke, clinically relevant bleeding, and mortality in patients with atrial fibrillation. Chest 146, 719–726 (2014).

    Article  PubMed  Google Scholar 

  146. Ruff, C. T. et al. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. Lancet 383, 955–962 (2014). A meta-analysis of the NOAC trials.

    Article  CAS  PubMed  Google Scholar 

  147. Connolly, S. J. et al. Effect of clopidogrel added to aspirin in patients with atrial fibrillation. N. Engl. J. Med. 360, 2066–2078 (2009).

    Article  PubMed  Google Scholar 

  148. Connolly, S. J. et al. Apixaban in patients with atrial fibrillation. N. Engl. J. Med. 364, 806–817 (2011).

    Article  CAS  PubMed  Google Scholar 

  149. Lip, G. Y. et al. Management of antithrombotic therapy in atrial fibrillation patients presenting with acute coronary syndrome and/or undergoing percutaneous coronary or valve interventions: a joint consensus document of the European Society of Cardiology Working Group on Thrombosis, European Heart Rhythm Association (EHRA), European Association of Percutaneous Cardiovascular Interventions (EAPCI) and European Association of Acute Cardiac Care (ACCA) endorsed by the Heart Rhythm Society (HRS) and Asia-Pacific Heart Rhythm Society (APHRS). Eur. Heart J. 35, 3155–3179 (2014). European consensus document on managing this complex group of patients.

    Article  CAS  PubMed  Google Scholar 

  150. Van Gelder, I. C. et al. Lenient versus strict rate control in patients with atrial fibrillation. N. Engl. J. Med. 362, 1363–1373 (2010). A classic trial examining lenient versus strict rate control in patients with AF.

    Article  CAS  PubMed  Google Scholar 

  151. Groenveld, H. F. et al. The effect of rate control on quality of life in patients with permanent atrial fibrillation: data from the RACE II (Rate Control Efficacy in Permanent Atrial Fibrillation II) study. J. Am. Coll. Cardiol. 58, 1795–1803 (2011).

    Article  PubMed  Google Scholar 

  152. Farshi, R., Kistner, D., Sarma, J. S., Longmate, J. A. & Singh, B. N. Ventricular rate control in chronic atrial fibrillation during daily activity and programmed exercise: a crossover open-label study of five drug regimens. J. Am. Coll. Cardiol. 33, 304–310 (1999).

    Article  CAS  PubMed  Google Scholar 

  153. Khand, A. U. et al. Carvedilol alone or in combination with digoxin for the management of atrial fibrillation in patients with heart failure? J. Am. Coll. Cardiol. 42, 1944–1951 (2003).

    Article  CAS  PubMed  Google Scholar 

  154. Chao, T.-F. et al. Rate-control treatment and mortality in atrial fibrillation. Circulation 132, 1604–1612 (2015).

    Article  CAS  PubMed  Google Scholar 

  155. Van Gelder, I. C., Hobbelt, A. H., Mulder, B. A. & Rienstra, M. Rate control in atrial fibrillation: many questions still unanswered. Circulation 132, 1597–1599 (2015).

    Article  PubMed  Google Scholar 

  156. Danias, P. G., Caulfield, T. A., Weigner, M. J., Silverman, D. I. & Manning, W. J. Likelihood of spontaneous conversion of atrial fibrillation to sinus rhythm. J. Am. Coll. Cardiol. 31, 588–592 (1998).

    Article  CAS  PubMed  Google Scholar 

  157. Crijns, H. J. et al. Contemporary real life cardioversion of atrial fibrillation: results from the multinational RHYTHM-AF study. Int. J. Cardiol. 172, 588–594 (2014).

    Article  PubMed  Google Scholar 

  158. Lafuente-Lafuente, C., Valembois, L., Bergmann, J. F. & Belmin, J. Antiarrhythmics for maintaining sinus rhythm after cardioversion of atrial fibrillation. Cochrane Database Syst. Rev. 3, CD005049 (2015). A systematic review of antiarrhythmic drugs for AF cardioversion.

    Google Scholar 

  159. Cadrin-Tourigny, J. et al. Efficacy of amiodarone in patients with atrial fibrillation with and without left ventricular dysfunction: a pooled analysis of AFFIRM and AF-CHF trials. J. Cardiovasc. Electrophysiol. 25, 1306–1313 (2014).

    Google Scholar 

  160. Savelieva, I., Graydon, R. & Camm, A. J. Pharmacological cardioversion of atrial fibrillation with vernakalant: evidence in support of the ESC Guidelines. Europace 16, 162–173 (2014).

    Article  PubMed  Google Scholar 

  161. Freemantle, N., Lafuente-Lafuente, C., Mitchell, S., Eckert, L. & Reynolds, M. Mixed treatment comparison of dronedarone, amiodarone, sotalol, flecainide, and propafenone, for the management of atrial fibrillation. Europace 13, 329–345 (2011).

    Article  PubMed  Google Scholar 

  162. Opolski, G. et al. Amiodarone in restoration and maintenance of sinus rhythm in patients with chronic atrial fibrillation after unsuccessful direct-current cardioversion. Clin. Cardiol. 20, 337–340 (1997).

    Article  CAS  PubMed  Google Scholar 

  163. Hohnloser, S. H., Connolly, S. J., John Camm, A., Halperin, J. L. & Radzik, D. An individual patient-based meta-analysis of the effects of dronedarone in patients with atrial fibrillation. Europace 16, 1117–1124 (2014).

    Article  PubMed  Google Scholar 

  164. Hohnloser, S. H. et al. Interaction between digoxin and dronedarone in the PALLAS trial. Circ. Arrhythm. Electrophysiol. 7, 1019–1025 (2014).

    Article  CAS  PubMed  Google Scholar 

  165. Lin, C. Y. et al. Factors predisposing to ventricular proarrhythmia during antiarrhythmic drug therapy for atrial fibrillation in patients with structurally normal heart. Heart Rhythm 12, 1490–1500 (2015).

    Article  PubMed  Google Scholar 

  166. Steinberg, B. A. et al. Use and outcomes of antiarrhythmic therapy in patients with atrial fibrillation receiving oral anticoagulation: results from the ROCKET AF trial. Heart Rhythm 11, 925–932 (2014).

    Article  PubMed  PubMed Central  Google Scholar 

  167. Flaker, G. et al. Amiodarone, anticoagulation, and clinical events in patients with atrial fibrillation: insights from the ARISTOTLE trial. J. Am. Coll. Cardiol. 64, 1541–1550 (2014).

    Article  CAS  PubMed  Google Scholar 

  168. Mohanty, S. et al. Effect of periprocedural amiodarone on procedure outcome in patients with longstanding persistent atrial fibrillation undergoing extended pulmonary vein antrum isolation: results from a randomized study (SPECULATE). Heart Rhythm 12, 477–483 (2015).

    Article  PubMed  Google Scholar 

  169. Darkner, S. et al. Recurrence of arrhythmia following short-term oral AMIOdarone after CATheter ablation for atrial fibrillation: a double-blind, randomized, placebo-controlled study (AMIO-CAT trial). Eur. Heart J. 35, 3356–3364 (2014).

    CAS  Google Scholar 

  170. Khitri, A. R. et al. Celivarone for maintenance of sinus rhythm and conversion of atrial fibrillation/flutter. J. Cardiovasc. Electrophysiol. 23, 462–472 (2012).

    Article  PubMed  Google Scholar 

  171. Ford, J. et al. Human electrophysiological and pharmacological properties of XEN-D0101: a novel atrial-selective Kv1.5/IKur inhibitor. J. Cardiovasc. Pharmacol. 61, 408–415 (2013).

    Article  CAS  PubMed  Google Scholar 

  172. Burashnikov, A. et al. Atrial-selective prolongation of refractory period with AVE0118 is due principally to inhibition of sodium channel activity. J. Cardiovasc. Pharmacol. 59, 539–546 (2012).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  173. Gupta, T., Khera, S., Kolte, D., Aronow, W. S. & Iwai, S. Antiarrhythmic properties of ranolazine: a review of the current evidence. Int. J. Cardiol. 187, 66–74 (2015).

    Article  PubMed  Google Scholar 

  174. Dittrich, H. C. et al. COR-ART: a multicenter, randomized, double-blind, placebo-controlled dose-ranging study to evaluate single oral doses of vanoxerine for conversion of recent-onset atrial fibrillation or flutter to normal sinus rhythm. Heart Rhythm 12, 1105–1112 (2015).

    Article  PubMed  Google Scholar 

  175. Kanj, M., Wazni, O. & Natale, A. Pulmonary vein antrum isolation. Heart Rhythm 4, S73–S79 (2007).

    Article  PubMed  Google Scholar 

  176. Webb, S., Kanani, M., Anderson, R. H., Richardson, M. K. & Brown, N. A. Development of the human pulmonary vein and its incorporation in the morphologically left atrium. Cardiol. Young 11, 632–642 (2001).

    Article  CAS  PubMed  Google Scholar 

  177. Raviele, A. et al. Venice chart international consensus document on atrial fibrillation ablation: 2011 update. J. Cardiovasc. Electrophysiol. 23, 890–923 (2012).

    Article  PubMed  Google Scholar 

  178. Di Biase, L. et al. Left atrial appendage: an underrecognized trigger site of atrial fibrillation. Circulation 122, 109–118 (2010).

    Article  PubMed  Google Scholar 

  179. Atienza, F. et al. Comparison of radiofrequency catheter ablation of drivers and circumferential pulmonary vein isolation in atrial fibrillation: a noninferiority randomized multicenter RADAR-AF trial. J. Am. Coll. Cardiol. 64, 2455–2467 (2014).

    Article  PubMed  Google Scholar 

  180. Brooks, A. G. et al. Outcomes of long-standing persistent atrial fibrillation ablation: a systematic review. Heart Rhythm 7, 835–846 (2010). A systematic review of AF ablation.

    Article  PubMed  Google Scholar 

  181. Verma, A. 1, Jiang, C. Y. et al. Approaches to catheter ablation for persistent atrial fibrillation. N. Engl. J. Med 372, 1812–1822 (2015).

    Article  PubMed  Google Scholar 

  182. Natale, A. et al. Paroxysmal AF catheter ablation with a contact force sensing catheter: results of the prospective, multicenter SMART-AF trial. J. Am. Coll. Cardiol. 64, 647–656 (2014).

    Article  PubMed  Google Scholar 

  183. Packer, D. L. et al. Cryoballoon ablation of pulmonary veins for paroxysmal atrial fibrillation: first results of the North American Arctic Front (STOP AF) pivotal trial. J. Am. Coll. Cardiol. 61, 1713–1723 (2013).

    Article  PubMed  Google Scholar 

  184. Dukkipati, S. R. et al. Pulmonary vein isolation using a visually guided laser balloon catheter: the first 200-patient multicenter clinical experience. Circ. Arrhythm. Electrophysiol. 6, 467–472 (2013).

    Article  PubMed  Google Scholar 

  185. Pappone, C. et al. Robotic magnetic navigation for atrial fibrillation ablation. J. Am. Coll. Cardiol. 47, 1390–1400 (2006).

    Article  PubMed  Google Scholar 

  186. Saliba, W. et al. Atrial fibrillation ablation using a robotic catheter remote control system: initial human experience and long-term follow-up results. J. Am. Coll. Cardiol. 51, 2407–2411 (2008).

    Article  PubMed  Google Scholar 

  187. Scharf, C. et al. Ablation of persistent atrial fibrillation using multielectrode catheters and duty-cycled radiofrequency energy. J. Am. Coll. Cardiol. 54, 1450–1456 (2009).

    Article  PubMed  Google Scholar 

  188. Haegeli, L. M. & Calkins, H. Catheter ablation of atrial fibrillation: an update. Eur. Heart J. 35, 2454–2459 (2014).

    Article  PubMed  Google Scholar 

  189. Cappato, R. et al. Updated worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circ. Arrhythm. Electrophysiol. 3, 32–38 (2010).

    Article  PubMed  Google Scholar 

  190. Sorgente, A. et al. Complications of atrial fibrillation ablation: when prevention is better than cure. Europace 13, 1526–1532 (2011).

    Article  PubMed  Google Scholar 

  191. Deshmukh, A. et al. In-hospital complications associated with catheter ablation of atrial fibrillation in the United States between 2000 and 2010: analysis of 93 801 procedures. Circulation 128, 2104–2112 (2013).

    Article  PubMed  Google Scholar 

  192. Calkins, H. et al. 2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design. Europace 14, 528–606 (2012). A contemporary consensus document on AF ablation.

    Article  PubMed  Google Scholar 

  193. Aliot, E., Botto, G. L., Crijns, H. J. & Kirchhof, P. Quality of life in patients with atrial fibrillation: how to assess it and how to improve it. Europace 16, 787–796 (2014).

    Article  PubMed  Google Scholar 

  194. Dorian, P. et al. The impairment of health-related quality of life in patients with intermittent atrial fibrillation: implications for the assessment of investigational therapy. J. Am. Coll. Cardiol. 36, 1303–1309 (2000).

    Article  CAS  PubMed  Google Scholar 

  195. Thrall, G., Lane, D., Carroll, D. & Lip, G. Y. Quality of life in patients with atrial fibrillation: a systematic review. Am J. Med 119, 448.e1–448.19 (2006). A systematic review on QOL in patients with AF.

    Article  Google Scholar 

  196. Pepine, C. J. Effects of pharmacologic therapy on health-related quality of life in elderly patients with atrial fibrillation: a systematic review of randomized and nonrandomized trials. Clin. Med. Insights Cardiol. 7, 1–20 (2013).

    Article  PubMed  PubMed Central  Google Scholar 

  197. Healey, J. S., Parkash, R., Pollak, T., Tsang, T. & Dorian, P. Canadian Cardiovascular Society atrial fibrillation guidelines 2010: etiology and initial investigations. Can. J. Cardiol. 27, 31–37 (2011).

    Article  PubMed  Google Scholar 

  198. Dorian, P. et al. Interpreting changes in quality of life in atrial fibrillation: how much change is meaningful? Am. Heart J. 166, 381–387.e8 (2013).

    Article  CAS  PubMed  Google Scholar 

  199. Anker, S. D. et al. The importance of patient-reported outcomes: a call for their comprehensive integration in cardiovascular clinical trials. Eur. Heart J. 35, 2001–2009 (2014).

    Article  PubMed  Google Scholar 

  200. Rienstra, M. et al. Symptoms and functional status of patients with atrial fibrillation: state of the art and future research opportunities. Circulation 125, 2933–2943 (2012).

    Article  PubMed  PubMed Central  Google Scholar 

  201. Wood, M. A., Brown-Mahoney, C., Kay, G. N. & Ellenbogen, K. A. Clinical outcomes after ablation and pacing therapy for atrial fibrillation: a meta-analysis. Circulation 101, 1138–1144 (2000).

    Article  CAS  PubMed  Google Scholar 

  202. Roy, D. et al. Amiodarone to prevent recurrence of atrial fibrillation. N. Engl. J. Med. 342, 913–920 (2000).

    Article  CAS  PubMed  Google Scholar 

  203. Singh, S. N. et al. Quality of life and exercise performance in patients in sinus rhythm versus persistent atrial fibrillation: a Veterans Affairs Cooperative Studies Program substudy. J. Am. Coll. Cardiol. 48, 721–730 (2006).

    Article  PubMed  Google Scholar 

  204. Lane, D. A., Apostolakis, S., Boos, C. J. & Lip, G. Y. Atrial fibrillation (chronic). BMJ Clin. Evid. 2011, 0217 (2011). An evidence review of drugs for rate and rhythm control in patients with AF.

    PubMed  PubMed Central  Google Scholar 

  205. Ha, A. C. et al. Health-related quality of life in patients with atrial fibrillation treated with rhythm control versus rate control: insights from a prospective international registry (Registry on Cardiac Rhythm Disorders Assessing the Control of Atrial Fibrillation: RECORD-AF). Circ. Cardiovasc. Qual. Outcomes 7, 896–904 (2014).

    Article  PubMed  Google Scholar 

  206. Hemels, M. E. et al. Favorable long-term outcome of Maze surgery in patients with lone atrial fibrillation. Ann. Thorac Surg. 81, 1773–1779 (2006).

    Article  PubMed  Google Scholar 

  207. Bonanno, C., Paccanaro, M., La Vecchia, L., Ometto, R. & Fontanelli, A. Efficacy and safety of catheter ablation versus antiarrhythmic drugs for atrial fibrillation: a meta-analysis of randomized trials. J. Cardiovasc. Med. 11, 408–418 (2010).

    Article  Google Scholar 

  208. Jais, P. et al. Catheter ablation versus antiarrhythmic drugs for atrial fibrillation: the A4 study. Circulation 118, 2498–2505 (2008).

    Article  PubMed  Google Scholar 

  209. Reynolds, M. R., Walczak, J., White, S. A., Cohen, D. J. & Wilber, D. J. Improvements in symptoms and quality of life in patients with paroxysmal atrial fibrillation treated with radiofrequency catheter ablation versus antiarrhythmic drugs. Circ. Cardiovasc. Qual. Outcomes 3, 615–623 (2010).

    Article  PubMed  Google Scholar 

  210. Walfridsson, H. et al. Radiofrequency ablation as initial therapy in paroxysmal atrial fibrillation: results on health-related quality of life and symptom burden. The MANTRA-PAF trial. Europace 17, 215–221 (2015).

    Article  CAS  PubMed  Google Scholar 

  211. Lip, G. Y. et al. Oral anticoagulation in atrial fibrillation: a pan-European patient survey. Eur. J. Intern. Med. 18, 202–208 (2007).

    Article  CAS  PubMed  Google Scholar 

  212. Clarkesmith, D. E., Pattison, H. M., Lip, G. Y. & Lane, D. A. Educational intervention improves anticoagulation control in atrial fibrillation patients: the TREAT randomised trial. PLoS ONE 8, e74037 (2013). An RCT of an educational intervention to improve the quality of anticoagulation control with warfarin.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  213. Dantas, G. C., Thompson, B. V., Manson, J. A., Tracy, C. S. & Upshur, R. E. Patients' perspectives on taking warfarin: qualitative study in family practice. BMC Fam. Prac. 5, 15 (2004).

    Article  Google Scholar 

  214. Das, A. K., Willcoxson, P. D., Corrado, O. J. & West, R. M. The impact of long-term warfarin on the quality of life of elderly people with atrial fibrillation. Age Ageing 36, 95–97 (2007).

    Article  PubMed  Google Scholar 

  215. Kirchhof, P. et al. Early and comprehensive management of atrial fibrillation: executive summary of the proceedings from the 2nd AFNET-EHRA consensus conference ‘research perspectives in AF’. Eur. Heart J. 30, 2969–2977c (2009).

    Article  PubMed  Google Scholar 

  216. Nattel, S. et al. Early management of atrial fibrillation to prevent cardiovascular complications. Eur. Heart J. 35, 1448–1456 (2014).

    Article  PubMed  Google Scholar 

  217. Jalife, J. & Kaur, K. Atrial remodeling, fibrosis, and atrial fibrillation. Trends Cardiovasc. Med. 25, 475–484 (2015).

    Article  CAS  PubMed  Google Scholar 

  218. Kirchhof, P. et al. Personalized management of atrial fibrillation: proceedings from the fourth Atrial Fibrillation competence NETwork/European Heart Rhythm Association consensus conference. Europace 15, 1540–1556 (2013).

    Article  PubMed  Google Scholar 

  219. Lee, G., Sanders, P. & Kalman, J. M. Catheter ablation of atrial arrhythmias: state of the art. Lancet 380, 1509–1519 (2012).

    Article  PubMed  Google Scholar 

  220. Hakalahti, A., Biancari, F., Nielsen, J. C. & Raatikainen, M. J. P. Radiofrequency ablation versus antiarrhythmic drug therapy as first line treatment of symptomatic atrial fibrillation: systematic review and meta-analysis. Europace 17, 370–378 (2015).

    Article  PubMed  Google Scholar 

  221. Kottkamp, H., Bender, R. & Berg, J. Catheter ablation of atrial fibrillation: how to modify the substrate? J. Am. Coll. Cardiol. 65, 196–206 (2015).

    Article  PubMed  Google Scholar 

  222. Weerasooriya, R., Shah, A. J., Hocini, M., Jaïs, P. & Haïssaguerre, M. Contemporary challenges of catheter ablation for atrial fibrillation. Clin. Ther. 36, 1145–1150 (2014).

    Article  PubMed  Google Scholar 

  223. Bax, J. J., Marsan, N. A. & Delgado, V. Non-invasive imaging in atrial fibrillation: focus on prognosis and catheter ablation. Heart 101, 94–100 (2015).

    Article  PubMed  Google Scholar 

  224. US National Library of Science. Catheter ablation versus anti-arrhythmic drug therapy for atrial fibrillation trial. ClinicalTrials.gov[online], (2009).

  225. Kirchhof, P. et al. Improving outcomes in patients with atrial fibrillation: rationale and design of the Early Treatment of Atrial Fibrillation for Stroke Prevention trial. Am. Heart J. 166, 442–448 (2013).

    Article  PubMed  Google Scholar 

  226. Hart, R. G. et al. Embolic strokes of undetermined source: the case for a new clinical construct. Lancet Neurol. 13, 429–438 (2014).

    Article  PubMed  Google Scholar 

  227. Jacobs, V. et al. The impact of risk score (CHADS2 versus CHA2DS2-VASc) on long-term outcomes after atrial fibrillation ablation. Heart Rhythm 12, 681–686 (2015).

    Article  PubMed  Google Scholar 

  228. Guo, Y. et al. Prevalence, incidence, and lifetime risk of atrial fibrillation in China: new insights into the global burden of atrial fibrillation. Chest 147, 109–119 (2015). A study on AF in China.

    Article  PubMed  Google Scholar 

  229. Lau, K.-K. et al. Roles of the CHADS2 and CHA2DS2-VASc scores in post-myocardial infarction patients: Risk of new occurrence of atrial fibrillation and ischemic stroke. Cardiol. J. 21, 474–483 (2014).

    Article  PubMed  Google Scholar 

  230. Melgaard, L. et al. Assessment of the CHA 2 DS 2 -VASc score in predicting ischemic stroke, thromboembolism, and death in patients with heart failure with and without atrial fibrillation. JAMA 314, 1030–1038 (2015). A large study showing how CHA2DS2VASC predicts outcomes in patients with heart failure without AF.

    Article  CAS  PubMed  Google Scholar 

  231. Boriani, G. et al. Non-valvular atrial fibrillation: potential clinical implications of the heterogeneous definitions used in trials on new oral anticoagulants. J. Cardiovasc. Med. (Hagerstown) 16, 491–496 (2015).

    Article  CAS  Google Scholar 

  232. Eikelboom, J. W. et al. Dabigatran versus warfarin in patients with mechanical heart valves. N. Engl. J. Med. 369, 1206–1214 (2013).

    Article  CAS  PubMed  Google Scholar 

  233. Kooiman, J. et al. Efficacy and safety of vitamin K-antagonists (VKA) for atrial fibrillation in non-dialysis dependent chronic kidney disease. PLoS ONE 9, e94420 (2014).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  234. Lega, J.-C. et al. Consistency of safety profile of new oral anticoagulants in patients with renal failure. J. Thromb. Haemost. 12, 337–343 (2014).

    Article  CAS  PubMed  Google Scholar 

  235. Pathak, R. K. et al. Aggressive risk factor reduction study for atrial fibrillation and implications for the outcome of ablation. J. Am. Coll. Cardiol. 64, 2222–2231 (2014).

    Article  PubMed  Google Scholar 

  236. Gami, A. S. et al. Obstructive sleep apnea, obesity, and the risk of incident atrial fibrillation. J. Am. Coll. Cardiol. 49, 565–571 (2007).

    Article  PubMed  Google Scholar 

  237. Stewart, S. et al. Standard versus atrial fibrillation-specific management strategy (SAFETY) to reduce recurrent admission and prolong survival: pragmatic, multicentre, randomised controlled trial. Lancet 385, 775–784 (2015). A study on the multidisciplinary management of AF and improved outcomes.

    Article  PubMed  Google Scholar 

  238. Ware, J. E. Jr& Sherbourne, C. D. The MOS 36-item Short-Form Health Survey (SF-36). I. Conceptual framework and item selection. Med. Care 30, 473–483 (1992).

    Article  PubMed  Google Scholar 

  239. Ware, J. E. Jr, Kosinski, M. & Keller, S. D. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med. Care 34, 220–233 (1996).

    Article  PubMed  Google Scholar 

  240. Kosinski, M. et al. A six-item short-form survey for measuring headache impact: the HIT-6. Qual. Life Res. 12, 963–974 (2003).

    Article  CAS  PubMed  Google Scholar 

  241. EuroQol Group. EuroQol — a new facility for the measurement of health-related quality of life. Health Policy 16, 199–208 (1990).

    Article  Google Scholar 

  242. Hunt, S. M., McEwen, J. & McKenna, S. P. Measuring health status: a new tool for clinicians and epidemiologists. J. R. Coll. Gen. Pract. 35, 185–188 (1985).

    CAS  PubMed  PubMed Central  Google Scholar 

  243. Nelson, E. C., Landgraf, J. M., Hays, R. D., Wasson, J. H. & Kirk, J. W. The functional status of patients. How can it be measured in physicians' offices? Med. Care 28, 1111–1126 (1990).

    Article  CAS  PubMed  Google Scholar 

  244. Spertus, J. et al. Development and validation of the Atrial Fibrillation Effect on QualiTy-of-Life (AFEQT) questionnaire in patients with atrial fibrillation. Circ. Arrhythm. Electrophysiol. 4, 15–25 (2011).

    Article  PubMed  Google Scholar 

  245. Arribas, F. et al. Validation of the AF-QoL, a disease-specific quality of life questionnaire for patients with atrial fibrillation. Europace 12, 364–370 (2010).

    Article  PubMed  Google Scholar 

  246. Badia, X., Arribas, F., Ormaetxe, J. M., Peinado, R. & de Los Terreros, M. S. Development of a questionnaire to measure health-related quality of life (HRQoL) in patients with atrial fibrillation (AF-QoL). Health Qual. Life Outcomes 5, 37 (2007).

    Article  PubMed  PubMed Central  Google Scholar 

  247. Braganca, E. O., Filho, B. L., Maria, V. H., Levy, D. & de Paola, A. A. Validating a new quality of life questionnaire for atrial fibrillation patients. Int. J. Cardiol. 143, 391–398 (2010).

    Article  PubMed  Google Scholar 

  248. Yamashita, T. Koretsune Y. et al. A new method for evaluating quality of life specific to patients with atrial fibrillation: Atrial Fibrillation Quality of Life Questionnaire (AFQLQ). Jpn J. Electrocardiol. 23, 332–343 (2003).

    Article  Google Scholar 

  249. Yamashita, T. et al. Internal consistency and reproducibility of Atrial Fibrillation Quality of Life Questionnaire. Jpn J. Electrocardiol. 25, 488–494 (2005).

    Article  Google Scholar 

  250. Shields, A. M. & Lip, G. Y. H. Choosing the right drug to fit the patient when selecting oral anticoagulation for stroke prevention in atrial fibrillation. J. Intern. Med. 278, 1–18 (2015).

    Article  CAS  PubMed  Google Scholar 

  251. Huxley, R. R. et al. Absolute and attributable risks of atrial fibrillation in relation to optimal and borderline risk factors: the Atherosclerosis Risk in Communities (ARIC) study. Circulation 123, 1501–1508 (2011).

    Article  PubMed  PubMed Central  Google Scholar 

  252. Watanabe, H. et al. Metabolic syndrome and risk of development of atrial fibrillation: the Niigata preventive medicine study. Circulation 117, 1255–1260 (2008).

    Article  PubMed  PubMed Central  Google Scholar 

  253. Baber, U. et al. Association of chronic kidney disease with atrial fibrillation among adults in the United States: REasons for Geographic and Racial Differences in Stroke (REGARDS) study. Circ. Arrhythm. Electrophysiol. 4, 26–32 (2011).

    Article  PubMed  Google Scholar 

  254. Liao, J.-N. et al. Incidence and risk factors for new-onset atrial fibrillation among patients with end-stage renal disease undergoing renal replacement therapy. Kidney Int. 87, 1209–1215 (2015).

    Article  PubMed  Google Scholar 

  255. Butt, M., Dwivedi, G., Khair, O. & Lip, G. Y. Obstructive sleep apnea and cardiovascular disease. Int. J. Cardiol. 139, 7–16 (2010).

    Article  PubMed  Google Scholar 

  256. Chao, T.-F. et al. Incidence and risk of atrial fibrillation in sleep-disordered breathing without coexistent systemic disease. Circ. J. 78, 2182–2187 (2014).

    Article  PubMed  Google Scholar 

  257. Chao, T.-F. et al. The association between hyperuricemia, left atrial size and new-onset atrial fibrillation. Int. J. Cardiol. 168, 4027–4032 (2013).

    Article  PubMed  Google Scholar 

  258. Nyrnes, A. et al. Uric acid is associated with future atrial fibrillation: an 11-year follow-up of 6308 men and women — the Tromso study. Europace 16, 320–326 (2014).

    Article  PubMed  Google Scholar 

  259. Chamberlain, A. M. et al. A clinical risk score for atrial fibrillation in a biracial prospective cohort (from the Atherosclerosis Risk in Communities [ARIC] study). Am. J. Cardiol. 107, 85–91 (2011).

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, UK

    Gregory Y. H. Lip & Deirdre A. Lane

  2. Department of Clinical Medicine, Aalborg Thrombosis Research Unit, Aalborg University, Aalborg, Denmark

    Gregory Y. H. Lip

  3. Faculty of Medicine, University of Tours, Tours, France

    Laurent Fauchier

  4. Heart Research Institute and Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia

    Saul B. Freedman

  5. Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands

    Isabelle Van Gelder

  6. Texas Cardiac Arrhythmia Institute, St David's Medical Center, Texas, Austin, USA

    Andrea Natale & Carola Gianni

  7. Medicine and Research Center and Department of Pharmacology McGill University, Montréal Heart Institute and University de Montréal, Montréal, Quebec, Canada

    Stanley Nattel

  8. Institute of Pharmacology, West German Heart and Vascular Center, Faculty of Medicine, University Duisburg-Essen, Essen, Germany

    Stanley Nattel

  9. Cardiology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia

    Tatjana Potpara

  10. University Medical Center, University of Groningen, Groningen, The Netherlands

    Michiel Rienstra

  11. Division of Cardiology, Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong

    Hung-Fat Tse

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  1. Gregory Y. H. Lip
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  2. Laurent Fauchier
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Contributions

Introduction (G.Y.H.L.); Epidemiology (T.P.); Mechanisms/pathophysiology (S.N.); Diagnosis, screening and prevention (S.B.F.); Management (A.N., C.G., G.Y.H.L., H.-F.T., I.V.G. and M.R.); Quality of life (D.A.L.); Outlook (L.F.); Overview of Primer (G.Y.H.L.).

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Correspondence to Gregory Y. H. Lip.

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Competing interests

G.Y.H.L. has had guideline membership or has been involved in reviewing the European Society of Cardiology (ESC) Guidelines on Atrial Fibrillation (2010) and Focused Update (2012), the ESC Guidelines on Heart Failure (2012), the American College of Chest Physicians Antithrombotic Therapy Guidelines for Atrial Fibrillation (2012), the National Institute for Health and Care Excellence (NICE) Guidelines on Atrial Fibrillation (2006 and 2014), the NICE Quality Standards on Atrial Fibrillation (2015), the ESC Cardio-oncology Task Force (2015) and the ESC Working Group on Thrombosis position documents (2011–present). He is the chairman of the Scientific Documents Committee for the European Heart Rhythm Association (EHRA) and a reviewer for various guidelines and position statements from the ESC, EHRA, NICE and other organizations. He has been a member of steering committees for various Phase II and III studies, Health Economics and Outcomes Research and other studies, and has been an investigator in various clinical trials in cardiovascular disease, including those on antithrombotic therapies in atrial fibrillation, acute coronary syndrome and lipids. He has been or is currently a consultant for Bayer/Janssen, Astellas, Merck, Sanofi, BMS/Pfizer, Biotronik, Medtronic, Portola, Boehringer Ingelheim, Microlife and Daiichi-Sankyo, and a speaker for Bayer, BMS/Pfizer, Medtronic, Boehringer Ingelheim, Microlife, Roche and Daiichi-Sankyo. L.F. has served as a consultant for Bayer HealthCare, Bristol-Myers Squibb/Pfizer, Boehringer Ingelheim, Medtronic and Novartis and has been on the speakers' bureau for Bayer HealthCare, Bristol-Myers Squibb/Pfizer, Boehringher Ingelheim, Boston Scientific and Medtronic. S.B.F. receives investigator-initiated research grants, personal fees and non-financial support from Bayer Pharma AG, investigator-initiated research grants and non-financial support from Boehringer Ingelheim, investigator-initiated research grants and personal fees from Bristol-Myers Squibb/Pfizer and personal fees from Servier, AstraZeneca and Gilead Sciences. These associations are not related to the submitted work. I.V.G. has had guideline membership of and been involved in reviewing the ESC Guidelines on Atrial Fibrillation (2010). She has received research grants that have been paid to the University Medical Center Groningen from Medtronic, Biotronik and St Jude Medical. A.N. has received consulting fees or honoraria from Janssen Pharmaceuticals, Biosense Webster, St Jude Medical, Medtronic and Boston Scientific. C.G. declares no competing interests. S.N. declares no competing interests. T.P. has received consultant and speaker fees from Bayer HealthCare, Pfizer and Boehringer Ingelheim. M.R. is supported by a grant from the Netherlands Organization for Scientific Research (Veni grant number 016.136.055). He declares no relationship with industry. H.-F.T. is chairman of the Clinical Trial Committee for the Asia Pacific Heart Rhythm Society. He has been or is currently a steering committee member and investigator in various clinical trials in cardiovascular disease, including those on antithrombotic therapies in atrial fibrillation, acute coronary syndrome and lipids. He has been or is currently a consultant for BayerHealthcare/Jensen J&J, MSD, Bristol-Myers Squibb/Pfizer, Boston Scientific, St Jude Medical, Medtronic, Boehringer Ingelheim and Daiichi-Sankyo, and a speaker for Bayer HealthCare/Jensen J&J, MSD, Bristol-Myers Squibb/Pfizer, Boston Scientific, St Jude Medical, Medtronic, Boehringer Ingelheim and Merck. D.A.L. has received investigator-initiated educational grants from Bayer HealthCare, Bristol-Myers Squibb and Boehringer Ingelheim and has been on the speaker bureau for Boehringer Ingelheim, Bayer HealthCare and Bristol-Myers Squibb/Pfizer. She is a steering committee member of a Bristol-Myers Squibb Phase IV trial.

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Lip, G., Fauchier, L., Freedman, S. et al. Atrial fibrillation. Nat Rev Dis Primers 2, 16016 (2016). https://doi.org/10.1038/nrdp.2016.16

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