Lone Atrial Fibrillation: Does It Exist? A White Paper of the Journal of the American College of Cardiology

摘要

The historical origin of the term ‘lone atrial fibrillation (AF)’ predates by 80 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 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 such 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 ‘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.