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Why a special issue on atrial fibrillation?

Atrial fibrillation (AF) is a public health crisis. At the age of 40, the estimated lifetime risk for developing AF is 26% for men and 23% for women. In the AF population, 84% are over the age of 65 and 32% are over the age of 80. The number of patients with AF is likely to increase 2.5 fold over the next 40 years, reflecting the growing proportions of elderly individuals. People with AF are five to seven times more likely to have a stroke than the general population. Atrial fibrillation can decrease the heart's pumping ability by as much as 20 to 25 percent, which combined with a fast heart rate over a long period of time can result in heart failure. The morbidity and mortality associated with AF are considerable. By causing dys-pnea, palpitations, strokes, and by precipitating or worsening heart failure, AF causes considerable suffering as well as frequent outpatient visits and hospitalizations. It is well recognized that the characteristics of patients with AF in the Gulf and Middle East may be different from the West in view of a younger population, a high prevalence of obesity, diabetes and smoking in oil-rich countries and a higher prevalence of rheumatic valvular heart disease in lower-income countries such as Yemen. If we look at extrapolated statistics regarding AF in the Middle East, we realize that the number will vary between 30,000 patients in Lebanon vs. 600,000 patients in Egypt [1]. With the introduction of new technologies to the Middle East, pulmonary vein isolation, left atrial appendage closure devices and novel oral anti-coagulation medicines, a new paradigm started in the management of AF patients in this part of the world. This special issue is designed to share the expertise of renowned people in the field of electrophysiology, toward a more complete understanding of the patho-physiology of atrial fibrillation with the primary goal of developing more effective strategies for the treatment of this common arrhythmia. A journey of a thousand miles begins with a single step. We hope to start a regional disease awareness initiative that will bring the best approach to patients with atrial fibrillation.