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Europace Advance Access published online on December 17, 2007
Europace, doi:10.1093/europace/eum276
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2007. For permissions please email: journals.permissions@oxfordjournals.org
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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.


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