Lone Atrial Fibrillation – An Overview

T. S. Potpara; G. Y. H. Lip

Disclosures

Int J Clin Pract. 2014;68(4):418-433. 

In This Article

Abstract and Introduction

Abstract

Atrial fibrillation (AF) sometimes develops in younger individuals without any evident cardiac or other disease. To refer to these patients who were considered to have a very favourable prognosis compared with other AF patients, the term 'lone' AF was introduced in 1953. However, there are numerous uncertainties associated with 'lone' AF, including inconsistent entity definitions, considerable variations in the reported prevalence and outcomes, etc. Indeed, increasing evidence suggests a number of often subtle cardiac alterations associated with apparently 'lone' AF, which may have relevant prognostic implications. Hence, 'lone' AF patients comprise a rather heterogeneous cohort, and may have largely variable risk profiles based on the presence (or absence) of overlooked subclinical cardiovascular risk factors or genetically determined subtle alterations at the cellular or molecular level. Whether the implementation of various cardiac imaging techniques, biomarkers and genetic information could improve the prediction of risk for incident AF and risk assessment of 'lone' AF patients, and influence the treatment decisions needs further research. In this review, we summarise the current knowledge on 'lone' AF, highlight the existing inconsistencies in the field and discuss the prognostic and treatment implications of recent insights in 'lone' AF pathophysiology.

Introduction

Since its first description in humans at the beginning of the 20th century,[1] atrial fibrillation (AF) has come a long way from a misperception of a relatively harmless substitute for normal sinus rhythm to understand that the arrhythmia is associated with significant cardiovascular morbidity and mortality,[2–4] mostly because of ischemic stroke (which is often deleterious in the setting of AF) and heart failure (HF).[5–8] In addition, AF may reduce exercise tolerance or impair the quality of life.[8–10]

At least 2% of general population is currently affected by AF,[11,12] and the number is expected to rise in the next several decades,[13] presumably because of the increasing number of individuals with 'novel' risk factors for AF (e.g., obesity), improved survival of patients with structural heart diseases, aging of the general population and increased awareness of AF among physicians and patients.[14,15] A number of underlying cardiac and non-cardiac disorders may predispose to AF ( Table 1 ).[16–42] Nonetheless, AF sometimes develops in younger individuals without any evident cardiac or other disease. To refer to these patients who were considered to have a very favourable prognosis compared with other AF patients, the term 'lone' AF was introduced.[2] However, there are numerous uncertainties associated with 'lone' AF, including inconsistent entity definitions, considerable variations in the reported prevalence and outcomes, etc..[43,44] Indeed, increasing evidence suggests a number of often subtle cardiac alterations associated with apparently 'lone' AF, which may have relevant prognostic implications.[43]

In this review, we summarise the current knowledge on 'lone' AF, highlight the existing inconsistencies in the field and discuss the prognostic and treatment implications of recent insights in 'lone' AF pathophysiology.

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