Ectopy and Expectations: Can We Predict Atrial Fibrillation, and Should We Try?
Authors: Daniel B. Kramer, Peter J. Zimetbaum
Journal: Annals of Internal Medicine (2013)

EditorialsDecember 3, 2013Ectopy and Expectations: Can We Predict Atrial Fibrillation, and Should We Try?Daniel B. Kramer, MD and Peter J. Zimetbaum, MDDaniel B. Kramer, MDFrom Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts. and Peter J. Zimetbaum, MDFrom Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-159-11-201312030-00014 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Despite advances in diagnostics and therapy, atrial fibrillation (AF) continues to place an enormous burden on patients and public health (1). Recent work aimed at reducing the morbidity and costs of AF include genetic insights into the substrate for AF (2), ablation-guided mechanistic studies (3), and striking advances in anticoagulant therapy (4). Yet strategies for predicting and preventing AF in routine outpatient practice remain elusive.In this issue, Dewland and colleagues (5) advance this discussion by presenting results from a substudy of the Cardiovascular Health Study, a large prospective cohort of more than 5000 Medicare beneficiaries drawn from 4 academic ...References1. Lubitz SA, Bauer KA, Benjamin EJ, Besdine RW, Forman DE, Gurol ME, et al. Stroke prevention in atrial fibrillation in older adults: existing knowledge gaps and areas for innovation: a summary of an American Federation for Aging Research seminar. J Am Geriatr Soc. 2013;61:1798-803. [PMID: 24083473] CrossrefMedlineGoogle Scholar2. Ellinor PT, Lunetta KL, Albert CM, Glazer NL, Ritchie MD, Smith AV, et al. Meta-analysis identifies 6 new susceptibility loci for atrial fibrillation. Nat Genet. 2012;44:670-5. [PMID: 22544366] CrossrefMedlineGoogle Scholar3. Narayan SM, Krummen DE, Clopton P, Shivkumar K, and Miller JM. Direct or coincidental elimination of stable rotors or focal sources may explain successful atrial fibrillation ablation: on-treatment analysis of the CONFIRM trial (Conventional ablation for AF with or without focal impulse and rotor modulation). J Am Coll Cardiol. 2013;62:138-47. [PMID: 23563126] CrossrefMedlineGoogle Scholar4. Dentali F, Riva N, Crowther M, Turpie AG, Lip GY, and Ageno W. Efficacy and safety of the novel oral anticoagulants in atrial fibrillation: a systematic review and meta-analysis of the literature. Circulation. 2012;126:2381-91. [PMID: 23071159] CrossrefMedlineGoogle Scholar5. Dewland TA, Vittinghoff E, Mandyam MC, Heckbert SR, Siscovick DS, Stein PK, et al. Atrial ectopy as a predictor of incident atrial fibrillation. A cohort study. Ann Intern Med. 2013;159:721-8. LinkGoogle Scholar6. Binici Z, Intzilakis T, Nielsen OW, Køber L, and Sajadieh A. Excessive supraventricular ectopic activity and increased risk of atrial fibrillation and stroke. Circulation. 2010;121:1904-11. [PMID: 20404258] CrossrefMedlineGoogle Scholar7. Lubitz SA and Husser D. Genomic risk scores in atrial fibrillation: predicting the unpredictable? [Editorial]. Eur Heart J. 2013;34:2227-9. [PMID: 23585492] CrossrefMedlineGoogle Scholar8. Engdahl J, Andersson L, Mirskaya M, and Rosenqvist M. Stepwise screening of atrial fibrillation in a 75-year-old population: implications for stroke prevention. Circulation. 2013;127:930-7. [PMID: 23343564] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.Grant Support: By a Paul B. Beeson Career Development Award in Aging Research (K23AG045963; Dr. Kramer).Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M13-2519.Corresponding Author: Peter J. Zimetbaum, MD, 185 Pilgrim Road, Boston, MA 02215; e-mail, [email protected].Current Author Addresses: Drs. Kramer and Zimetbaum: Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Road, Boston, MA 02115. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAtrial Ectopy as a Predictor of Incident Atrial Fibrillation Thomas A. Dewland , Eric Vittinghoff , Mala C. Mandyam , Susan R. Heckbert , David S. Siscovick , Phyllis K. Stein , Bruce M. Psaty , Nona Sotoodehnia , John S. Gottdiener , and Gregory M. Marcus Metrics December 3, 2013Volume 159, Issue 11Page: 787-788KeywordsAlgorithmsAnticoagulant therapyArrhythmiaAtrial fibrillationDiagnostic techniquesElderlyElectrocardiographyEpidemiologyForecastingGeneticsMedicareMorbidityOutpatientsPatientsPhenotypesPrevention, policy, and public healthProspective studiesSpecificityStroke ePublished: 3 December 2013 Issue Published: December 3, 2013 CopyrightCopyright © 2013 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...