Pathophysiology and disease progression of atrial fibrillation: importance of achieving and maintaining sinus rhythm.

Atrial fibrillation (AF) is a progressive disease in which arrhythmia-induced remodeling facilitates evolution from paroxysmal AF to persistent and permanent AF. Changes in electrical, structural, and contractile properties of cardiac tissue that are thought to underlie AF maintenance and progression are reviewed. Also examined is the negative impact of AF on clinical outcomes, as well as the potential benefits of restoration and maintenance of sinus rhythm. Because of the limited efficacy and adverse effects of current antiarrhythmics, new antiarrhythmic drugs need to be developed that provide safer and more effective rhythm control in AF.