Recent developments in atrial fibrillation

BMJ 2005; 330 doi: http://dx.doi.org/10.1136/bmj.330.7485.238 (Published 27 January 2005)
Cite this as: BMJ 2005;330:238

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  1. M Bilal Iqbal, senior house officer, cardiology1,
  2. Anil K Taneja (a.taneja@rbh.nthames.nhs.uk), senior clinical research fellow, cardiology1,
  3. Gregory Y H Lip, professor of cardiovascular medicine2,
  4. Marcus Flather, director1
  1. 1 Clinical Trials and Evaluation Unit, Royal Brompton Hospital, London SW3 6NP
  2. 2 University Department of Medicine, City Hospital, Birmingham B18 7QH
  1. Correspondence to: A K Taneja
  • Accepted 22 November 2004

Introduction

Atrial fibrillation, the most commonly encountered arrhythmia in clinical practice, is associated with substantial morbidity and mortality. Its incidence and prevalence are increasing, and it represents a growing clinical and economic burden. Recent research has highlighted new approaches to both pharmacological and non-pharmacological management strategies. Clinicians need to have a sound working knowledge of atrial fibrillation and to be up to date with the emerging evidence to guide treatment and improve outcomes in these patients.

Sources and selection criteria

In this article, we highlight the recent advances in atrial fibrillation. We searched PubMed/Medline, Embase, and Cochrane databases by using the keywords “atrial fibrillation,” “rate,” “rhythm,” “anticoagulation,” and “non-pharmacological.” We also searched references of recent major articles and key reviews, and we obtained articles where necessary.

Epidemiology

Atrial fibrillation affects an estimated 2.2 million adults in the United States.1 In the United Kingdom alone, more than 46 000 new cases of atrial fibrillation are diagnosed every year.2 The prevalence of atrial fibrillation doubles with each advancing decade from the age of 50.3 Independent risk factors include male sex, increasing age, hypertension, diabetes, smoking, valvular heart disease, and myocardial infarction.4 Left atrial dilatation, left ventricular hypertrophy, and impaired left ventricular systolic function are also associated with atrial fibrillation.5 Compared with people in sinus rhythm, those in atrial fibrillation have a sixfold increased risk of stroke and twofold increased risk of death. For those with rheumatic heart disease, the risk of stroke is increased up to 18-fold.6

Classification

The nomenclature used to classify atrial fibrillation has been diverse. Recent guidelines recommend a classification system based on the temporal pattern of the arrhythmia (fig 1).7

Fig 1

Classification of atrial fibrillation.*When a patient has had two or more episodes of atrial fibrillation, this is termed recurrent. Both paroxysmal and persistent atrial fibrillation …

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