Transitioning towards life-cycle management and burden monitoring of atrial fibrillation.

INTRODUCTION: Atrial fibrillation (AF) poses a significant burden on public health, being associated with substantial morbidity and mortality. In most cases, disease progression follows a continuum, ranging from a predominantly electrical disorder to late stages characterized by profound disruption of atrial architecture and advanced atrial cardiomyopathy.

AREAS COVERED: Common cardiovascular risk factors play a pivotal role in the progression and self-perpetuation of AF by promoting left atrial remodeling, creating the substrate necessary for the maintenance of the arrhythmia. Correction of these risk factors, together with rhythm-control strategies, can delay and, in some cases, interrupt disease progression while improving patients' quality of life. Catheter ablation, when combined with life-style modifications and risk factors management, has the potential to positively modify the arrhythmogenic substrate that favors AF and could promote reverse atrial remodeling.

EXPERT OPINION: Comprehensive management of risk factors and comorbidities, together with novel ablation techniques (e.g. pulsed field ablation) and the development of atrial-selective antiarrhythmic drugs, may further improve AF care. In addition, redefining long-term rhythm control success from freedom from AF recurrence to AF burden may allow better patient stratification, inform therapeutic decisions, and ultimately improve patient outcomes.