Modifiable Risk Factors and Atrial Fibrillation: the Quest for a Personalized Approach

Abstract

Background:Atrial fibrillation (AF) is the most common tachyarrhythmia, affecting up to 4% of the general population. Susceptibility to AF episodes can be explained by various risk factors (RF) that alter the substrate of the left atrium. Association between several RF and AF development and recurrence has been demonstrated in several studies. Areas of uncertainty: Treatment strategies depend on patients' characteristics and comorbidities. Medical literature and consensus documents recommend an integrated approach, but also identify evidence gaps in treating patients with severe comorbidities. Data sources: Literature search was performed using PubMed electronic database. We used the following terms as key words: atrial fibrillation, risk factors, comorbidities, primary prevention, secondary prevention. Results: Active intervention helps control the burden of AF and increase the chances of a positive outcome on the long term. Aggressive control and individualized treatment of most prevalent modifiable risk factors can reduce the risk of atrial fibrillation. Optimization of treatment strategy should be performed periodically, since RF and comorbidities are dynamic and often evolve. Conclusion:Personalized strategies should be applied to each patient after careful assessment of individual risk. A personalized approach is indicated to both reduce the burden of AF and improve symptoms, quality of life and survival. Close attention to details is required to avoid disease and therapy related complications in the presence of comorbidities.

FIGURE 1.

Mechanisms related to development and persistence of atrial fibrillation

TABLE 1.

Angiotensin converting enzyme inhibitors (ACEI) and angiotensin-receptor blockers (ARB) in primary or secondary prevention of atrial fibrillation; AF = atrial fibrillation