Atrial fibrillation through the lens of precision medicine: what clinicians need to know

Atrial fibrillation (AF) is the most common cardiac arrhythmia and its prevalence expected to double by 2060. This is due to aging populations and increasing rates of obesity, hypertension, and diabetes. It is often asymptomatic and can go undetected which will intensify the risk of serious complications such as ischemic stroke, heart failure, and cognitive decline. Early detection through opportunistic and systematic screening is essential for anticoagulation therapy, which can reduce stroke risk by 65%. AF arises from disorganized atrial electrical activity that is frequently originating in the pulmonary veins, and is sustained by a complex interplay of electrical, structural, and autonomic factors. Lifestyle and dietary habits play a significant role in AF risk and progression with obesity, and alcohol consumption linked to increased risk, while heart-healthy diets and weight control can alleviate symptoms and reduce recurrence. Additionally, genetic predisposition contributes to AF, particularly in early-onset cases. Genome-wide studies have identified over 100 associated loci, highlighting the value of personalized approaches in diagnosis and treatment. This paper explores the epidemiology, pathophysiology, and modifiable risk factors of AF with a dedicated focus on the precision medicine approach by highlighting personalized strategies for early detection and targeted management despite current clinical challenges.