Atrial Fibrillation

Copyright © 2013 Natig Gassanov et al. is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Atrial brillation (AF) is the most common clinically important cardiac arrhythmia. e prevalence of AF roughly doubles with each advancing decade of age, from 0.5% at age of 50–59 years to almost 9% at age of 80–89 years [1]. AF is associated with substantial morbidity and mortality. us, AF is a signicant risk factor for ischemic stroke and accounts for 15–20% of all strokes [2]. Considering the clinical relevance of AF, this journal initiated a special issue dealing with the recent developments in AF over the past few years. is issue contains important work—both review and original articles—addressing the epidemiology, economic impact of AF, and new therapeutic/diagnostic developments and their potential clinical implications. e general therapeutic strategies in AF include heart rate or rhythm control and anticoagulation. Current drugs used for AF therapy have major limitations, including incomplete efficacy and risks of life-threatening proarrhythmic events and bleeding complications. However, there have been several recent advancements in therapy of AF. ey included the availability of new anticoagulants, such as dabigatran, rivaroxaban, and apixaban, as well as guideline changes to incorporate the catheter-based isolation of pulmonary veins (PV) as a class IIa/A indication [3]. Since the rst paper evidencing the role of PV as triggers of AF [4], various ablation techniques targeting PV (focal ablation, PV isolation, circumferential antral ablation, cryoballoon) were introduced into clinical practice [5, 6]. ough PV isolation by catheter-based radiofrequency ablation has become an effective treatment option in AF, the studies on long-term outcomes are still limited and less encouraging. Recently, F. Ouyang et al. examined 5-year outcomes in paroxysmal AF and found that sinus rhythm was present in 46.6% of patients aer one procedure [7]. Long-term outcome data aer catheter ablation for persistent AF are even less favourable [8]. ese data highlight important aspects of catheter ablation, in particular the need for improved tools for patient selection, energy delivery for durable transmural lesions, and more studies on long-term outcomes and the management of very late recurrences as mediators of initial procedural approach renement. Radiological investigations such as CT scan or cardiac magnetic resonance imaging (cMRI) can demonstrate the complex LA anatomy very well in all three dimensions and should reduce …