Emerging treatments
Biomarker-based risk prediction
Like many conditions, there is a growing interest in the roles that cardiac biomarkers play in pathogenesis and, hence, the treatment aspect of atrial fibrillation (AF). Biomarker-based risk prediction scores, such as ABC-AF, may become an adjunct to existing scores such as CHA₂DS₂-VASc.[186]
New technologies for AF detection
Wearables, such as smart watches, can incorporate optical sensors to provide heart rate and rhythm information, and several studies have evaluated their use in detecting AF. For example, the Apple Heart Study found around 0.5% of over 400,000 participants received an alert about potential AF from their smartwatch irregular pulse notification algorithm. Patients who received this alert were followed up with a wearable ECG patch for up to 7 days. Of patients who returned analyzable ECG patches, AF was present in 34%. For patients notified of an irregular pulse while wearing the ECG patch, there was a positive predictive value of simultaneously observing AF on the ECG of 0.84 (95% CI 0.76-0.92).[187] Further large-scale studies are needed to provide clarity on the role of new monitoring technologies in the early detection of AF.[3] Another emerging area of interest is screening for AF in elderly people with the aim of preventing strokes, for example by using a hand-held ECG recorder or implantable loop recorder. Results to date are mixed, with new data expected.[3]
Ethanol infusion
Infusion of ethanol into the vein of Marshall has been investigated for treatment of persistent AF. One meta-analysis found that compared with ablation alone, ablation with vein of Marshall ethanol infusion was associated with a higher rate of long-term freedom from AF and comparable safety.[188]
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