Atrial fibrillation in the ‘real world’: undecided issues

Atrial fibrillation (AF) is an obstinate and widespread arrhythmia with multiple presentations and potential for hazardous consequences. Although our knowledge of AF is advancing, the onset and progression of AF and the interaction with its many associated diseases is not fully understood. Also, management recommendations on evidence based issues are frequently ignored for a wide range of reasons. The following developments are expected to improve efficacy, safety, and guideline adherence regarding the management of AF: earlier detection of AF, improved understanding and management of its associated diseases, adequate rate-control targets, more effective and safer rhythm control measures, an easy-to-use risk stratification scheme incorporating both risk factors for stroke and major bleeding to tailor antithrombotic treatment, and anticoagulation drugs not requiring monitoring of the international normalized ratio. Translational researchers, clinical trialists, and epidemiologists should complement each other to fulfil the current needs in the management of AF and to monitor whether there are solutions for existing ‘undecided issues’ and new ones are developing.