Over time, atrial fibrillation (AF) naturally progresses from initially paroxysmal
to persistent/permanent AF caused by structural and electrical remodelling with a
complex underlying pathogenesis. It has been demonstrated that this progression of
AF itself is linked to negative cardiovascular outcomes (stroke, systemic embolism,
and hospitalization due to heart failure). Consequently, there is a profound rationale
for early treatment of AF as a cornerstone of AF management. Recent randomized trials
produced evidence that early rhythm control is effective in maintaining sinus rhythm,
lower the risk of cardiovascular outcomes, and that catheter ablation of AF is effective
to delay AF progression. This review will illuminate current evidence regarding the
hypothesis of early AF treatment to prevent AF progression and improve clinical outcomes.
