Atrial Fibrillation: How to Move Forward in This Complex Arrhythmia

Atrial fibrillation (AF) is typically classified by episode duration (paroxysmal, persistent, long-standing persistent, and permanent).Multiple mechanisms have been proposed underlying AF (multiple rotors, focal sources, wavelet hypothesis, epi-endo dissociation, micro reentry, ...).However, despite extensive study, pulmonary vein isolation (PVI) remains the only proven ablation treatment for paroxysmal AF.This work aims to address critical challenges to progress AF research.1. Complexity: The trend towards increasingly complex models, such as digital twins, raises the question of whether we fully understand simpler models.We revisit a fundamental theorem in atrial tachycardia that was overlooked for more than three decades despite existing evidence, suggesting that simpler models may still hold untapped insights.2. Open Source Code: Limited availability of open-source codes for analyzing AF data impedes research, while many companies restrict access to their proprietary tools.3. Data Accessibility: The scarcity of publicly available datasets, due to privacy concerns and reluctance to share, hampers progress.4. Heterogeneity: AF might be highly variable, with different pathologies manifesting as AF, suggesting that uniform treatment approaches may not be suitable.This work aims to challenge existing paradigms and advocate for a collaborative and transparent approach to AF research.