American Heart Association Atrial Fibrillation Research Summit: A Conference Report From the American Heart Association

Atrial fibrillation (AF) poses a major global public health challenge because it is increasing in prevalence and is associated with an increased risk of stroke, dementia, heart failure, and death.1–3 In response to the many challenges posed by AF, the American Heart Association (AHA) convened a conference in Washington, DC, on June 12–13, 2010, that included patients, nurses, physicians, and healthcare policy makers and regulators. In addition, basic, translational, population, outcomes, and clinical scientists participated (Appendix). The 22 presentations and 6 panel discussions were organized into 4 sessions: (1) Mechanisms of AF: Basic and Translational Science and Genetics; (2) Epidemiology, Outcomes, Cost, AF, and Stroke Prevention; (3) Meeting the Clinical Challenges in AF; and (4) Redefining the Therapeutic Goals of AF (Appendix). The focus of the present report is to provide an overview of the key concepts presented and the core recommendations made by the summit participants. Attempts to develop safe and effective pharmacological therapy for AF have focused on atrium-selective drugs that take advantage of electrophysiological differences between the atrium and ventricle.4–7 Heterogeneous abbreviation of the effective refractory period within the atrium provides the electric substrate for development of AF. The reduced effective refractory period results from abbreviation of the atrial action potential duration, which is caused by a decrease in the calcium channel current ( ICa ) and an increase in the potassium channel current ( IK1 ) and the constitutively active acetylcholine-sensitive current (CA IKACh ).4–7 Maintenance of AF is facilitated by structural remodeling and additional abbreviation of the effective refractory period. The principal goal of pharmacological therapy is therefore to augment the effective refractory period. Distinctions in the ion channel currents between the atrium and ventricle open the possibility for development of atrium-specific and -selective drugs for rhythm …

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