Atrial fibrillation and acute coronary syndrome

Atrial fibrillation (AF) poses a significant burden to healthcare systems, physicians and patients, due to its high prevalence (affecting at least 3% of adults worldwide); increased risk of major adverse events, including stroke and systemic embolism; heart failure; hospitalisation; impaired quality of life and mortality; and comprehensive multidomain treatment requirements that are often challenging for both the patient and the responsible physician1.

Most patients with AF are clinically complex, i.e., elderly and multimorbid. Indeed, AF shares many common risk factors and often coexists with numerous comorbidities, including, for example, heart failure or coronary artery disease1. Multidirectional interactions among any underlying comorbidities, coexistent cardiovascular risk factors and AF all profoundly affect overall cardiovascular wellbeing and atrial substrate (i.e., atrial cardiomyopathy), thus increasing the risk of AF-related major adverse events. Discerning the exact role of AF in such a milieu may sometimes be challenging, as AF could be the main driver of adverse events or just a bystander (i.e., a consequence of multiple pathological processes)2.

In this issue of EuroIntervention, Bor and colleagues report their observations on the incidence and characteristics...