The management of atrial fibrillation (AF) has focused on anticoagulation, rhythm control and ventricular rate control. Recently, a fourth pillar of AF management has been incorporated recognising the importance of risk factor management (RFM). There are several risk factors that contribute to the development and progression of AF, these include traditional risk factors such as age, hypertension, heart failure, diabetes and valvular heart disease. However, increasingly it is recognised that obesity, sleep apnoea, hyperlipidaemia, smoking, alcohol, physical inactivity, genetics, aortic stiffness are associated with the development of AF. Importantly, several of these risk factors are modifiable. We have seen the evolution of RFM programmes which have demonstrated promising results. Indeed, the evidence is now so compelling that major clinical guidelines strongly advocate that aggressive treatment of these risk factors as a key component of AF management. Patients with AF who comprehensively managed their risk factors demonstrate greater reduction in symptoms, AF burden, more successful ablations and improved outcomes with greater AF freedom. In this article, we will review the evidence for the association between cardiac risk factors and AF and assess the burgeoning evidence for improved AF outcomes associated with aggressive cardiac RFM.
- atrial fibrillation
- metabolic syndrome
- smoking cessation
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Contributors All authors have contributed to the writing of the manuscript.
Funding MEM is supported by Postdoctoral Fellowships from the University of Adelaide. DL is supported by a Fellowship from the Hospital Research Foundation and by the Robert J Craig Lectureship from the University of Adelaide. PS is supported by Practitioner Fellowships from the National Health and Medical Research Council of Australia. PS are supported by the National Heart Foundation of Australia.
Competing interests DL reports that the University of Adelaide has received on his behalf lecture, travel and/or research funding from Abbott Medical, Bayer, Boehringer Ingelheim, Biotronik and Medtronic. PS reports having served on the advisory board of Medtronic, Abbott Medical, Boston Scientific, CathRx and Pacemate. PS reports that the University of Adelaide has received on his behalf lecture and/or consulting fees from Medtronic, Abbott Medical and Boston Scientific. PS reports that the University of Adelaide has received on his behalf research funding from Medtronic, Abbott Medical, Boston Scientific and Microport.
Patient consent for publication Not required.
Provenance and peer review Commissioned; externally peer reviewed.