Risk Factor Management and Atrial Fibrillation Clinics: Saving the Best for Last? - 02/08/17

Doi : 10.1016/j.hlc.2017.05.123

Rajiv Mahajan, MD, PhD ^a, Rajeev K. Pathak, MBBS, PhD ^a,^b, Anand Thiyagarajah, MBBS ^a, Dennis H. Lau, MBBS, PhD ^a, Francis E. Marchlinski, MD ^b, Sanjay Dixit, MD ^b, John D. Day, MD ^c, Jeroen M.L. Hendriks, PhD ^a, Melinda Carrington, PhD ^d, Jonathan M. Kalman, MBBS, PhD ^e, Prashanthan Sanders, MBBS, PhD ^a,^⁎
^a Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, SA, Australia
^b Cardiac Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
^c Intermountain Medical Center Heart Institute, Intermountain Medical Center, Murray, UT, USA
^d Baker IDI, Melbourne, Vic, Australia
^e Department of Cardiology, Royal Melbourne Hospital and the University of Melbourne, Melbourne, Vic, Australia

^⁎Corresponding author at: Centre for Heart Rhythm Disorders, Department of Cardiology, Royal Adelaide Hospital, Adelaide, SA 5000, Australia. Tel: +61 8 8222 2723; Fax: +61 8 8222 2722.Centre for Heart Rhythm DisordersSouth Australian Health and Medical Research InstituteUniversity of Adelaide and Royal Adelaide HospitalAdelaideSAAustralia

Résumé

Atrial fibrillation (AF) is a leading cause of cardiovascular morbidity and mortality worldwide. Management of AF is a complex process involving: 1) the prevention of thromboembolic complications with anticoagulation; 2) rhythm control; and 3) the detection and treatment of underlying heart disease. However, cardiometabolic risk factors, such as obesity, hypertension, diabetes mellitus, and obstructive sleep apnoea, have been proposed as contributors to the expanding epidemic of atrial fibrillation (AF). Thus, a fourth pillar of AF care would include aggressive targeting of interdependent, modifiable cardiovascular risk factors as part of an integrated care model. Such risk factor management could retard and reverse the pathological processes underlying AF and reduce AF burden.

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Keywords : Atrial fibrillation, Cardiovascular risk factors, Atrial remodelling