Early and comprehensive management of atrial fibrillation: executive summary of the proceedings from the 2nd AFNET-EHRA consensus conference ‘research perspectives in AF’
Open accessAbstract
Atrial fibrillation (AF) causes important mortality and morbidity on a population-level. So far, we do not have the means to prevent AF or AF-related complications adequately. Therefore, over 70 experts on atrial fibrillation convened for the 2nd AFNET/EHRA consensus conference to suggest directions for research to improve management of AF patients (Supplementary Data). The group defined three main areas in need for research in AF: 1. better understanding of the mechanisms of AF; 2. Improving rhythm control monitoring and management; and 3. comprehensive cardiovascular risk management in AF patients. The group put forward the hypothesis that successful therapy of AF and its associated complications will require comprehensive therapy. This applies e.g. to the “old” debate of “rate versus rhythm control”, since rhythm control is generally added to underlying (continued) rate control therapy, but also to the emerging debate of “antiarrhythmic drugs versus catheter ablation”, of which both may be needed in most patients to maintain sinus rhythm, but also to therapy of conditions that predispose to AF and contribute to cardiovascular complications such as stroke, cognitive decline, heart failure, and acute coronary syndromes. We call for research initiatives aiming at a better understanding of the different causes of AF and its complications, and at development and validation of mechanism-based therapies. The future of AF therapy may require a combination of management of underlying and concomitant conditions, early and comprehensive rhythm control therapy, adequate control of ventricular rate and cardiac function, and continuous therapy to prevent AF-associated complications (e.g. antithrombotic therapy). The reasons for these suggestions are detailed in this paper.
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Paroxysmal AF is often missed.
“Paroxysmal AF is often missed.120”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [120]
Silent, undetected AF is common.
“Silent, undetected AF is common, 120,122 with severe consequences such as stroke and death.[123][124][125]”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [120]
Repeated daily ECG recordings increased the detection of silent, asymptomatic paroxysmal AF in an unselected Swedish population aged >75 years.
“Repeated daily ECG recordings increased the detection of silent, asymptomatic paroxysmal AF in an unselected Swedish population aged > 75 years.120,135”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [120]
Asymptomatic recurrences of AF are common in patients with symptomatic AF.
“Furthermore, asymptomatic recurrences of AF are common in patients with symptomatic AF. 120”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [120]
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Self-citationDeterminants of atrial fibrillation development in patients with hypertrophic cardiomyopathy
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Self-citationIncidence and Predictors of Very Late Recurrence of Atrial Fibrillation After Ablation
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Self-citationPeriprocedural bridging therapy in patients receiving chronic oral anticoagulation therapy
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Critical Atrial Site for Ablation of Pacing‐Induced Atrial Fibrillation in the Normal Dog Heart
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Self-citationRadiofrequency catheter ablation of atrial fibrillation initiated by spontaneous ectopic beats
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Self-citationThe Autonomic Innervation of the Ligament of Marshall
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2013 ESH/ESC Guidelines for the management of arterial hypertension
Authors Task Force Members, Mancia, G., Fagard, R., Narkiewicz, K., Redon, J., Zanchetti, A., Böhm, M., Christiaens, T., Cífková, R., Backer, G. D., et al. (2013) · European Heart Journal · doi:10.1093/eurheartj/eht151 · Cited by 13,638 · see citing works
Self-citation2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation
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Self-citation2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
Kirchhof, P. F., Benussi, S., Kotecha, D., Ahlsson, A., Atar, D., Casadei, B., Castellà, M., Diener, H., Heidbüchel, H., Hendriks, J., et al. (2016) · EP Europace · doi:10.1093/europace/euw295 · Cited by 6,438 · see citing works
Self-citation2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
Kirchhof, P., Benussi, S., Kotecha, D., Ahlsson, A., Atar, D., Casadei, B., Castella, M., Diener, H.-C., Heidbuchel, H., Hendriks, J., et al. (2016) · European Heart Journal · doi:10.1093/eurheartj/ehw210 · Cited by 6,418 · see citing works
Self-citationGuidelines for the management of atrial fibrillation
Authors/Task Force Members, Camm, A. J., Kirchhof, P. F., Lip, G. Y. H., Schotten, U., Savelieva, I., Ernst, S., Gelder, I. C. V., Al‐Attar, N., Hindricks, G., et al. (2010) · European Heart Journal · doi:10.1093/eurheartj/ehq278 · Cited by 5,875 · see citing works
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Self-citation2014 ESC/EACTS Guidelines on myocardial revascularization
Authors Task Force Members, Windecker, S., Kolh, P., Alfonso, F., Collet, J., Cremer, J., Falk, V., Filippatos, G., Hamm, C. W., Head, S. J., et al. (2014) · European Heart Journal · doi:10.1093/eurheartj/ehu278 · Cited by 4,340 · see citing works
Self-citation2014 ESC/EACTS Guidelines on myocardial revascularization
Kolh, P. H., Windecker, S., Alfonso, F., Collet, J., Cremer, J., Falk, V., Filippatos, G. S., Hamm, C. W., Head, S. J., Jüni, P., et al. (2014) · European Journal of Cardio-Thoracic Surgery · doi:10.1093/ejcts/ezu366 · Cited by 4,211 · see citing works
Self-citation2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation
January, C. T., Wann, L. S., Alpert, J. S., Calkins, H., Cigarroa, J. E., Cleveland, J. C., Conti, J. B., Ellinor, P. T., Ezekowitz, M. D., Field, M. E., et al. (2014) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2014.03.022 · Cited by 2,955 · see citing works
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Self-citationEarly Rhythm-Control Therapy in Patients with Atrial Fibrillation
Kirchhof, P. F., Camm, A. J., Goette, A., Brandes, A., Eckardt, L., Elvan, A., Fetsch, T., Gelder, I. C. V., Haase, D., Haegeli, L., et al. (2020) · New England Journal of Medicine · doi:10.1056/nejmoa2019422 · Cited by 2,227 · see citing works
Self-citationGuidelines for the management of atrial fibrillation
Authors/Task Force Members, Camm, A. J., Kirchhof, P. F., Lip, G. Y. H., Schotten, U., Savelieva, I., Ernst, S., Gelder, I. C. V., Al‐Attar, N., Hindricks, G., et al. (2010) · EP Europace · doi:10.1093/europace/euq350 · Cited by 1,749 · see citing works
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Self-citation2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
Kirchhof, P., Benussi, S., Kotecha, D., Ahlsson, A., Atar, D., Casadei, B., Castella, M., Diener, H.-C., Heidbuchel, H., Hendriks, J., et al. (2016) · European Journal of Cardio-Thoracic Surgery · doi:10.1093/ejcts/ezw313 · Cited by 1,403 · see citing works
Self-citationPathophysiological mechanisms of atrial fibrillation: a translational appraisal
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Self-citation2013 ESH/ESC Practice Guidelines for the Management of Arterial Hypertension
Mancia, G., Fagard, R., Narkiewicz, K., Redón, J., Zanchetti, A., Böhm, M., Christiaens, T., Cífková, R., Backer, G. D. D., Dominiczak, A., et al. (2014) · Blood Pressure · doi:10.3109/08037051.2014.868629 · Cited by 643 · see citing works
Self-citationRadiofrequency ablation as initial therapy in paroxysmal atrial fibrillation
Cosedis Nielsen, J., Johannessen, A., Raatikainen, P., Hindricks, G., Walfridsson, H., Kongstad, O., Pehrson, S., Englund, A., Hartikainen, J., Mortensen, L. S., et al. (2012) · New England Journal of Medicine · doi:10.1056/nejmoa1113566 · Cited by 720 · see citing works
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2013 ESH/ESC Guidelines for the management of arterial hypertension
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- Authors
- Kirchhof, P., Bax, J., Blomstrom-Lundquist, C., Calkins, H., Camm, A. J., Cappato, R., Cosio, F., Crijns, H., Diener, H.-C., Goette, A., Israel, C. W., Kuck, K.-H., Lip, G. Y. H., Nattel, S., Page, R. L., Ravens, U., Schotten, U., Steinbeck, G., Vardas, P., Waldo, A., Wegscheider, K., Willems, S., & Breithardt, G.
- Affiliations
- University of Münster (DE)
- Leiden University (NL)
- Uppsala University (SE)
- Johns Hopkins University (US)
- St George's, University of London (GB)
- Policlinico S. Matteo 6 Department of Cardiology , , Pavia ,
- Hospital Telleras 7 , Madrid ,
- Maastricht University (NL)
- University of Duisburg-Essen (DE)
- Otto-von-Guericke-Universität Magdeburg (DE)
- Goethe University Frankfurt (DE)
- General Hospital St Georg 12 Department of Cardiology , , Hamburg ,
- University of Birmingham (GB)
- Montreal Heart Institute (CA)
- University of Washington (US)
- Technische Universität Dresden (DE)
- Ludwig-Maximilians-Universität München (DE)
- University of Crete (GR)
- Case Western Reserve University (US)
- Universität Hamburg (DE)
- Corresponding author
- Kirchhof, Paulus
- ORCID
- Venue
- European Heart Journal
- Publisher
- Oxford University Press (OUP)
- Published
- 2009-06-17
- Volume
- 30
- Issue
- 24
- Pages
- 2969-2980
- ISSN
- 0195-668X (ISSN-L)
- 1522-9645
- OpenAlex
- W1970627024
- Cited by
- 202
- References
- 140
- Citations by year
- 2026: 4 · 2025: 5 · 2024: 2 · 2023: 7 · 2022: 12 · 2021: 14 · 2020: 8 · 2019: 6 · 2018: 8 · 2017: 10 · 2016: 14 · 2015: 13 · 2014: 16 · 2013: 16 · 2012: 23
- FWCI
- 14.45
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- European Heart Journal (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion)
- Funders
- Kompetenznetz Vorhofflimmern
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Keywords
- atrial fibrillation, atrial fibrillation management, rhythm control, rate control, antiarrhythmic drugs, catheter ablation, cardiovascular risk management, stroke prevention, antithrombotic therapy, heart failure, cognitive decline, acute coronary syndrome, mechanism-based therapy, atrial fibrillation mechanisms
- MeSH terms
- Anti-Arrhythmia Agents, Atrial Fibrillation, Fibrinolytic Agents, Humans, Patient Compliance, Risk Factors, Risk Management, Catheter Ablation, Stroke
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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