Skip Navigation



Europace Advance Access published online on December 17, 2007
Europace, doi:10.1093/europace/eum276
This Article
Right arrow Full Text Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrowOA All Versions of this Article:
10/1/21    most recent
eum276v1
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Google Scholar
Right arrow Articles by Cosio, F. G.
Right arrow Articles by Crijns, H.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Cosio, F. G.
Right arrow Articles by Crijns, H.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2007. For permissions please email: journals.permissions@oxfordjournals.org
The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that the original authorship is properly and fully attributed; the Journal, Learned Society and Oxford University Press are attributed as the original place of publication with correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions©oxfordjournals.org.

POSITION PAPER

Delayed rhythm control of atrial fibrillation may be a cause of failure to prevent recurrences: reasons for change to active antiarrhythmic treatment at the time of the first detected episode

Francisco G. Cosio1,*, Etienne Aliot2, Giovanni Luca Botto3, Hein Heidbüchel4, Christoph Johan Geller5, Paulus Kirchhof6, Jean-Claude De Haro7, Robert Frank8, Perez Julian Villacastin9, Johan Vijgen10 and Harry Crijns11

1 Hospital Universitario de Getafe, Carretera de Toledo, km 12,5 Getafe, 28905 Madrid, Spain; 2 Hôpital de Brabois, Nancy, France; 3 Sant'Anna Hospital, Como, Italy; 4 University Hospital Gasthuisberg, Leuven, Belgium; 5 Zentralklinik Bad Berka, Germany; 6 Kompetenznetz Vorhofflimmern und Medizinische Klinik und Poliklinik C, Kardiologie und Angiologie, Muenster, Germany; 7 Hôpital de La timone, Marseille, France; 8 Hôpital Pitie Salpetriere, Paris, France; 9 University Hospital San Carlos, Madrid, Spain; 10 Virga Jesse Hospital, Hasselt, Belgium; 11 University Hospital Maastricht, The Netherlands

Atrial fibrillation (AF) is associated with impaired functional capacity and quality of life and significant morbidity and mortality. The current management approach fails to maintain stable sinus rhythm (SR) in the majority of patients. For many years, guidelines have recommended antiarrhythmic treatment of a first AF episode only if the AF is poorly tolerated, a position that has been reinforced by studies showing no mortality or morbidity advantage of rhythm control over rate control. During the last decade, research has shown mechanisms of self-perpetuation of AF based on electrophysiological and structural remodelling induced by AF itself. There is mounting evidence that ‘lone’ AF is because of a host of factors, some of which may be easily treatable, such as hypertension, sleep apnoea, and obesity, thus allowing secondary prevention at the time of the first episode of AF. According to these concepts, lack of early intervention could be one of the reasons for long-term failure of maintenance of SR. In this position paper, we propose testing the working hypothesis that if an SR maintenance strategy is selected, treatment of AF should commence at the first-detected episode and should be based on a double strategy of SR restoration and aggressive treatment of associated conditions that promote atrial remodelling.

Key Words: First-detected atrial fibrillation, Antiarrhythmic, Angiotensin, Atrial remodelling

* Corresponding author. Tel: +34 91 683 0781; fax: +34 91 683 9826. E-mail address: fgarciacosio.hugf{at}salud.madrid.org

Manuscript submitted 21 October 2007. Accepted after revision 21 November 2007.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?




Disclaimer:
Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department.