Atrial fibrillation: Yesterday, today, and tomorrow

Background. Advances in electrophysiological research have led to a modern understanding of the mechanisms of atrial fibrillation — the most common sustained cardiac arrhythmia, which poses a risk of severe, often disabling, and fatal complications. Although there have also been advances in pharmacology and rapid progress in interventional treatment methods, atrial fibrillation still cannot be completely eliminated in patients. Objectives. To examine the key stages in the development and improvement of medical care for patients with atrial fibrillation from a historical perspective, taking into account the widely accepted rate and rhythm control strategies and using data from both international and Russian scientific literature. Methods. An analysis of literature sources by international and Russian authors dedicated to the issues of diagnosis, pharmacological, and non-pharmacological treatment of atrial fibrillation was carried out. In order to search for the sources, the Russian scientific electronic library eLibrary.ru and the biomedical research search engine PubMed were used. Results. Throughout the 20th and 21st centuries, antiarrhythmic drugs capable of successfully restoring sinus rhythm were developed; however, the challenge of its long-term maintenance with such medications has remained unresolved. The development and increasingly widespread use of surgical, and especially catheter ablation in the left atrium, have the potential to improve the effectiveness of atrial fibrillation treatment. Recently, the importance of individualizing the management strategy for patients with atrial fibrillation has been growing, with mandatory consideration of their clinical characteristics. The main direction for future research could be the development of more effective and safer antiarrhythmic drugs for their rational use in combination with innovative non-pharmacological treatment technologies for atrial fibrillation. Conclusion. This paper presents the most important advances in medical care for patients with atrial fibrillation. It outlines potential approaches to minimizing its negative impact on patients’ quality of life and prognosis