Abstract

Background: Since its introduction in 1953, lone atrial fibrillation (LAF) has not been defined with any consistency, resulting in an enormous variation in the way the term is used. Inherent to this, results from studies vary considerably. Many predisposing factors and pathogenetic influences have been discovered over the past years, which raises the question if the term LAF should still be used and if the treatment should be different from non-lone atrial fibrillation (non-LAF). This review aims to provide an update of the current knowledge on risk factors and triggers of LAF, and secondly the application of catheter and surgical ablation procedures for LAF.

Methods: A systematic literature search was performed in the PubMed database. All identified articles were screened and checked for eligibility by the two authors. In addition, literature was sought by screening references of eligible articles.
Results: The term LAF is used very variably and inconsistently, and results concerning etiology in different studies are often contradictory. Overall finding is that LAF has many risk factors (i.e. subclinical atherosclerosis, enlarged left atrial diameter, left ventrical dysfunction, occult hypertension, arterial stiffness, systemic inflammation, genetic factors) and can be induced by many different triggers (i.e. use of substances, endurance sports, mental stress, sleeping). However, compared to non-LAF there are no unique mechanisms related to LAF. Concerning the therapy, catheter ablation is first or second choice after anti arrhythmic drugs, though results seem to be in favour of surgical and hybrid approaches.

Conclusion: Insufficient evidence exists to consider LAF as a real, isolated and useful entity. A re-definition or even avoiding the use of the term LAF might be appropriate.