Technological Advances Transforming the Clinical Practice of Atrial Fibrillation

Abstract

Atrial fibrillation (AF) is the most common arrhythmia causing stroke, myocardial infarction, and heart failure. An early diagnosis and treatment are crucial to reduce AF recurrence, progression of the disease and to improve prognosis. Thus, an opportunistic screening is recommended in people older than 65 years.

With the advent of digital medicine, there are a vast variety of wearables to enable an ECG-based or photoplethysmography-based notification for an irregular heart rhythm. Adopting digital health platforms facilitates remote monitoring of these notifications and integrating data from wearable devices, smartphones, and patient-reported outcomes, allowing healthcare providers to track AF in real-time and adjust management strategies proactively, leading to prompt and personalized treatment. However, there are some challenges to overcome such as managing an overwhelming volume of information, and storing health data raises concerns about patient privacy and data that we further develop in this revision.

Indeed, the complexity of AF requires a comprehensive, patient-centered management strategy for optimal outcomes. The AF-CARE pathway simplifies the approach and focuses on managing comorbidities and risk factors, anticoagulation, rate, and rhythm control, and continuous patient reassessment.

Rhythm control strategies employed in the past decade, including the safer use of antiarrhythmic drugs and catheter ablation, have been shown to provide significant symptomatic improvement and reduce cardiovascular mortality and morbidity when initiated early. Technological advances in catheter ablation have enabled a paradigm shift towards single-shot procedures, using specialized catheters that deliver energy to isolate the pulmonary veins in a single application (“single shot”). These ablation techniques, incorporating cryoablation and more recently pulsed field ablation, represent an advancement in the treatment of atrial fibrillation, offering improved outcomes and safety for patients.

As consequence of the benefit and safety of catheter ablation, the 2024 European guidelines state that catheter ablation can be recommended as a first-line option within a shared decision-making rhythm control strategy for patients with paroxysmal AF to reduce symptoms, recurrence, and progression of AF.