Spotlight on atrial fibrillation—the 'complete arrhythmia'

The French sometimes refer to atrial fibrillation (AF) as ‘l'arythmie complete’, which literally means ‘the complete arrhythmia’. The actual sense in French is that AF results in complete irregularity of cardiac rhythm. However, AF can also be considered the ‘complete’ arrhythmia in the sense of the consummate nature of its mechanisms and determinants. There is evidence for involvement of all forms of arrhythmia mechanisms in AF, including enhanced automaticity, delayed afterdepolarizations, early afterdepolarizations and reentry. A rich and wide range of determinants have been found to be involved in the pathophysiology of AF—various forms of ionic remodeling, structural remodeling, changes in connexin function and distribution, a whole gamut of signaling systems, anatomical determinants related to the complex three-dimensional atrial structure, hemodynamic factors and the involvement of electrical activity in the great veins. Research on the mechanisms of AF, and related therapeutic developments, has exploded over the past 10 years, and the present Spotlight Issue of Cardiovascular Research is meant to express some of this effervescence. The first historical reference to what may have been AF appeared approximately 4000 years ago, in The Yellow Emperor's Classic of Internal Medicine (Huang Ti Nei Ching Su Wen): “When the pulse is irregular and tremulous and the beats occur at intervals, then the impulse of life fades” [1]. In the late 1700s, William Withering described a patient with a weak, irregular pulse that became “more full and more regular” after treatment with extracts from the foxglove ( Digitalis purpurea ) [1]. Bouilland described “ataxia of the pulse” in 1835, referring to a pulse with varying inter-beat intervals [2]. Nothnagel used recently-developed graphical techniques of analyzing arterial pulses to describe a condition in which “heartbeats follow each other in complete irregularity…, the height and tension of the individual pulse waves are continuously changing”, which … * Corresponding author. Tel.: +1-514-376-3330; fax: +1-514-376-1355