Author + information
- Received December 1, 2013
- Revision received December 29, 2013
- Accepted January 2, 2014
- Published online May 6, 2014.
- D. George Wyse, MD, PhD∗∗ (, )
- Isabelle C. Van Gelder, MD, PhD†,
- Patrick T. Ellinor, MD, PhD‡,
- Alan S. Go, MD§,
- Jonathan M. Kalman, MBBS, PhD‖,
- Sanjiv M. Narayan, MD, PhD¶,
- Stanley Nattel, MD#,
- Ulrich Schotten, PhD∗∗ and
- Michiel Rienstra, MD, PhD†
- ∗Libin Cardiovascular Institute of Alberta/University of Calgary, Calgary, Alberta, Canada
- †Department of Cardiology, Thoraxcenter, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- ‡Cardiac Arrhythmia Service and Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts
- §Division of Research, Kaiser Permanente Northern California, Oakland, California
- ‖Department of Cardiology, Royal Melbourne Hospital, and Department of Medicine, University of Melbourne, Melbourne, Australia
- ¶University of California and Veterans' Affairs Medical Centers, San Diego, California
- #Department of Medicine and Research Center, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
- ∗∗Department of Physiology, University Maastricht, Maastricht, the Netherlands
- ↵∗Reprint requests and correspondence:
Dr. D. George Wyse, Emeritus Professor, Department of Cardiac Sciences, Libin Cardiovascular Institute/University of Calgary, Room GC64, Health Research Innovation Center, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada.
The historical origin of the term “lone atrial fibrillation” (AF) predates by 60 years our current understanding of the pathophysiology of AF, the multitude of known etiologies for AF, and our ability to image and diagnose heart disease. The term was meant to indicate AF in patients for whom subsequent investigations could not demonstrate heart disease, but for many practitioners has become synonymous with “idiopathic AF.” As the list of heart diseases has expanded and diagnostic techniques have improved, the prevalence of lone AF has fallen. The legacy of the intervening years is that definitions of lone AF in the literature are inconsistent so that studies of lone AF are not comparable. Guidelines provide a vague definition of lone AF but do not provide direction about how much or what kind of imaging and other testing are necessary to exclude heart disease. There has been an explosion in the understanding of the pathophysiology of AF in the last 20 years in particular. Nevertheless, there are no apparently unique mechanisms for AF in patients categorized as having lone AF. In addition, the term “lone AF” is not invariably useful in making treatment decisions, and other tools for doing so have been more thoroughly and carefully validated. It is, therefore, recommended that use of the term “lone AF” be avoided.
Dr. Wyse has received honoraria for serving on data and safety advisory boards for randomized clinical trials sponsored by Boehringer Ingelheim, Bristol Myers Squibb/Pfizer, Sanofi Aventis, Biotronik, Boston Scientific/Guidant (Europe), Medtronic, Merck, and St. Jude Medical. Dr. Ellinor is supported by grants from the National Institutes of Health (R01HL092577, R01HL104156, 1K24HL105780) and the American Heart Association (13EIA14220013). Dr. Go has received research support from iRhythm. Dr. Kalman has received fellowship or research support from Medtronic, St. Jude Medical, Biosense Webster, and Boston Scientific. Dr. Narayan is supported by a grant from the National Institutes of Health (HL103800); is coauthor of intellectual property owned by the University of California Regents and licensed to Topera Inc. (Topera does not sponsor any research, including that presented here) and holds equity in Topera; and reports having received honoraria from Medtronic, St. Jude Medical, and Biotronik. Dr. Rienstra is supported by a grant from the Netherlands Organization for Scientific Research (Veni grant 016.136.055). There was no financial support for this work other than that provided by the Journal for the meeting in Denver during Heart Rhythm 2013. All other authors have reported they have no relationships relevant to the contents of this paper to disclose.
- Received December 1, 2013.
- Revision received December 29, 2013.
- Accepted January 2, 2014.
- American College of Cardiology Foundation