Deja vu in the theories of atrial fibrillation dynamics

This brief review looks back to the major theoretical, experimental, and clinical work on the dynamics and mechanisms of atrial fibrillation (AF). Its goal is to highlight the most important issues, controversies, and advances that have driven the field of investigation into AF mechanisms at any given time during the last ∼100 years. It emphasizes that while the history of AF research has been full of controversies from the start, such controversies have led to new information, and individual scientists have learned from those that have preceded them. However, in the face of the most common sustained cardiac arrhythmia seen in clinical practice, we are yet to fully understand its fundamental mechanisms and learn how to treat it effectively. Future research into AF dynamics and mechanisms should focus on the development and validation of new numerical and animal models. Such models should be relevant to and accurately reproduce the important substrates associated with ageing and with diseases such as hypertension, heart failure, and ischaemic heart disease which cause AF in the vast majority of patients. Knowledge derived from such models may help to greatly advance the field and hopefully lead to more effective prevention and therapy.