Research Team Recommends Dropping Term 'Lone AFib'
The term 'lone atrial fibrillation (AFib)'was coined in 1954 to describe AFib in patients who had no detectable cardiac disease, but as diagnostic techniques and the understanding of the variable pathophysiology of cardiac dysfunction have progressed, lone AFib and the synonymous idiopathic AFib have become impediments to understanding and treating heart disease, according to authors of a white paper published Feb 12 in the Journal of the American College of Cardiology. The authors ultimately recommend that the term 'lone AFib' should be dropped.
According to the research team, led by D. George Wyse, MD, PhD, FACC, lone AFib as a clinical descriptor is hobbled by a rainbow of different definitions. Depending on the study, the patient population and the diagnostic tools used, the reported prevalence of lone AFib varies from 0.2 percent to 68 percent. It is unclear whether lone AFib is AFib without heart disease or AFib with heart disease that has not been recognized in a particular setting or in a particular patient population. Lone AFib also could be AFib diagnosed using a particular set of tools that may, or may not, have been specified by a study protocol or adequately described by investigators. Studies of the outcome of lone AFib are equally confusing because of inconsistent or unspecified populations, tools, definitions and techniques, according to the paper.
"While we currently cannot specify the precise mechanism for AFib in each patient, the goal of a mechanistic classification for AFib is moving from an inconceivable notion to a realistic scientific objective," wrote the authors. "The majority of patients without traditional heart disease likely develop AFib as a result of multiple influences. These influences lead to structural changes in the heart that have only recently been imaged or even conceptualized, and could be considered new heart disease forms," they add.
They conclude that "a consideration of our current state of knowledge about AFib and the inconsistency in usage of the term leads to the logical proposal that the historical term 'lone AFib' should be avoided." They note that moving forward, "a thorough search for risk factors and cardiovascular disease is recommended. Future studies should investigate whether optimal treatment of these risk factors may prevent or delay the development of AFib, improve maintenance of sinus rhythm and ultimately improve prognosis once AFib appears."
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