Can We Predict the Occurrence of Atrial Fibrillation?

Abstract

Atrial fibrillation (AF) is a complex disease with increasing prevalence in an aging population and longer survival with cardiovascular diseases. Whereas most clinical efforts have been aimed at predicting risk of AF sequelae such as stroke and heart failure, little is known on primary prevention. AF risk assessment is complicated by the existence of distinct subtypes of AF, such as lone AF or postoperative AF, in contrast to common AF in the elderly. Due to its often intermittent nature, diagnosing AF can be a challenge. Risk prediction becomes reasonable when specific interventions arise. Due to our limited understanding of AF pathophysiology and substantial lack of specific preventive strategies in the population, modification of the general cardiovascular risk profile has largely remained the only option. Initial attempts at combining established risk factors for AF such as age, sex, hypertension, body mass index, electrocardiographic characteristics, and cardiovascular disease in a riskprediction instrument have produced a robust algorithm. However, known risk factors only explain a fraction of the population-attributable risk of AF, and the search for novel risk indicators is ongoing. More efficient monitoring for electrocardiographic precursors of AF and the field of genomics are evolving areas of AF risk factor research. A better understanding of the underlying substrate of AF will provide targets for prevention. In the future, clinical trials will be needed to establish risk categories, interventions, and their efficacy. Despite a relevant public-health impact, knowledge on risk prediction and primary prevention of AF is still limited today.

Epidemiology of Arrhythmias and Conduction Disorders in Older Adults

“…[45] Increased left atrial size, which provides an anatomical substrate for wavelets of micro-re-entry, is common among elderly individuals, and is an independent predictor of AF. [46] An age-related increase in left ventricular stiffness, with resulting diastolic dysfunction and elevated left atrial pressure, may also serve as an important contributor.…”

Incidence, Risk Factors and Outcomes of New Onset Supraventricular Arrhythmias in African American Patients with Severe Sepsis

“…However, in contrast to reported associations in the general population, new onset SVA or AF was not higher with comorbidities such as hypertension, ischemic heart disease, diabetes, and COPD in our study. 30,32,33 Similarly, two previous studies paradoxically reported that diabetes mellitus was associated with a decreased risk of AF onset 5,34 indicating acute factors, rather than preexisting cardiovascular comorbid conditions, are associated with increased risk for newly diagnosed AF during sepsis. This suggests that mechanisms of newly diagnosed SVA/AF during severe sepsis may differ from the general population of patients with AF.…”

Stroke and Bleeding Risk in Atrial Fibrillation: Navigating the Alphabet Soup of Risk‐Score Acronyms (CHADS2, CHA2DS2‐VASc, R2CHADS2, HAS‐BLED, ATRIA, and More)

“…The increasing prevalence of atrial fibrillation (AF) brings a high burden of arrhythmia‐related complications, among which stroke is the most disabling and associated with high mortality and morbidity . Stroke prevention is central to the management of patients with AF.…”