Challenges and Opportunities for Atrial Fibrillation Management

Abstract Atrial fibrillation (AF) is the most common sustained arrhythmia worldwide and is associated with poor clinical outcomes and a huge economic burden on healthcare systems. Optimized anticoagulation, better symptom control via rhythm or rate control, and comprehensive comorbidity/risk factor management are 3 essential pillars of current AF management, where much progress has been made during the past decades. However, numerous challenges in AF management remain at the disease, patient, and population levels, including an incomplete understanding of basic mechanisms that can be clinically targeted; heterogenous progressive natural history; poor correlation between rhythm and symptoms/outcomes; as well as suboptimal detection methods and treatment options. Recent advances in disease perception in combination with modern monitoring devices, state-of-the art computational models, and novel antiarrhythmic drugs and ablation strategies can contribute to addressing these issues, ultimately leading to a paradigm shift in AF diagnosis, classification, and treatment. This narrative review summarizes these key challenges and future opportunities in the field of AF management.