Key result
Comprehensive risk-factor management and rhythm control may delay AF progression and reduce arrhythmia burden.
Why the study?
Atrial fibrillation causes substantial morbidity and mortality, typically progressing along a continuum from a predominantly electrical disorder to profound disruption of atrial architecture and advanced atrial cardiomyopathy.
This review highlights that combining risk factor modification with rhythm-control strategies (such as novel ablation techniques) and shifting the metric of success to AF burden may delay disease progression and improve outcomes in atrial fibrillation.
INTRODUCTION: Atrial fibrillation (AF) poses a significant burden on public health, being associated with substantial morbidity and mortality. In most cases, disease progression follows a continuum, ranging from a predominantly electrical disorder to late stages characterized by profound disruption of atrial architecture and advanced atrial cardiomyopathy. AREAS COVERED: Common cardiovascular risk factors play a pivotal role in the progression and self-perpetuation of AF by promoting left atrial remodeling, creating the substrate necessary for the maintenance of the arrhythmia. Correction of these risk factors, together with rhythm-control strategies, can delay and, in some cases, interrupt disease progression while improving patients' quality of life. Catheter ablation, when combined with life-style modifications and risk factors management, has the potential to positively modify the arrhythmogenic substrate that favors AF and could promote reverse atrial remodeling. EXPERT OPINION: Comprehensive management of risk factors and comorbidities, together with novel ablation techniques (e.g. pulsed field ablation) and the development of atrial-selective antiarrhythmic drugs, may further improve AF care. In addition, redefining long-term rhythm control success from freedom from AF recurrence to AF burden may allow better patient stratification, inform therapeutic decisions, and ultimately improve patient outcomes.
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Poggio et al. (2026) conducted a review in Atrial fibrillation. Risk factor management and rhythm-control strategies (including catheter ablation) was evaluated. Risk factor management combined with rhythm-control strategies and catheter ablation may delay atrial fibrillation progression, promote reverse atrial remodeling, and reduce AF burden.
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