Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Mar 26, 2016; 8(3): 267-276
Published online Mar 26, 2016. doi: 10.4330/wjc.v8.i3.267
Prediction of atrial fibrillation development and progression: Current perspectives
Konstantinos Vlachos, Konstantinos P Letsas, Panagiotis Korantzopoulos, Tong Liu, Stamatis Georgopoulos, Athanasios Bakalakos, Nikolaos Karamichalakis, Sotirios Xydonas, Michael Efremidis, Antonios Sideris
Konstantinos Vlachos, Konstantinos P Letsas, Stamatis Georgopoulos, Athanasios Bakalakos, Nikolaos Karamichalakis, Sotirios Xydonas, Michael Efremidis, Antonios Sideris, Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, “Evangelismos” General Hospital of Athens, 10676 Athens, Greece
Panagiotis Korantzopoulos, First Department of Cardiology, University Hospital of Ioannina, 45110 Ioannina, Greece
Tong Liu, Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China
Author contributions: Vlachos K and Georgopoulos S wrote the paper; Vlachos K and Xydonas S performed research; Letsas KP, Korantzopoulos P, Liu T, Bakalakos A, Karamichalakis N, Efremidis M and Sideris A designed research, and performed research; all authors read and approved the final version of the manuscript.
Conflict-of-interest statement: None to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Konstantinos P Letsas, MD, FESC, Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, “Evangelismos” General Hospital of Athens, 45-47 Ipsilantou Street, 10676 Athens, Greece.
Telephone: +30-210-7201466 Fax: +30-213-2041344
Received: June 4, 2015
Peer-review started: June 4, 2015
First decision: August 6, 2015
Revised: December 16, 2015
Accepted: January 5, 2016
Article in press: January 7, 2016
Published online: March 26, 2016

Atrial fibrillation (AF) is the most common arrhythmia in clinical practice. Several conventional and novel predictors of AF development and progression (from paroxysmal to persistent and permanent types) have been reported. The most important predictor of AF progression is possibly the arrhythmia itself. The electrical, mechanical and structural remodeling determines the perpetuation of AF and the progression from paroxysmal to persistent and permanent forms. Common clinical scores such as the hypertension, age ≥ 75 years, transient ischemic attack or stroke, chronic obstructive pulmonary disease, and heart failure and the congestive heart failure, hypertension, age ≥ 75 years, diabetes mellitus, stroke/transient ischemic attack, vascular disease, age 65-74 years, sex category scores as well as biomarkers related to inflammation may also add important information on this topic. There is now increasing evidence that even in patients with so-called lone or idiopathic AF, the arrhythmia is the manifestation of a structural atrial disease which has recently been defined and described as fibrotic atrial cardiomyopathy. Fibrosis results from a broad range of factors related to AF inducing pathologies such as cell stretch, neurohumoral activation, and oxidative stress. The extent of fibrosis as detected either by late gadolinium enhancement-magnetic resonance imaging or electroanatomic voltage mapping may guide the therapeutic approach based on the arrhythmia substrate. The knowledge of these risk factors may not only delay arrhythmia progression, but also reduce the arrhythmia burden in patients with first detected AF. The present review highlights on the conventional and novel risk factors of development and progression of AF.

Keywords: Atrial fibrillation, Development, Progression, Risk factors, Inflammation, Fibrosis

Core tip: Atrial fibrillation (AF) is a progressive disease associated with increased morbidity and mortality. Prevention of arrhythmia progression is therefore of paramount importance. An intense rhythm control strategy will prevent structural and electrical remodelling. The modification of common risk factors of AF development and progression such as hypertension, obesity, and sleep apnoea should be additionally considered. Emerging risk factors such as inflammation and fibrosis will guide the therapeutic approach in the future.