Atrial Fibrillation in Singapore and Malaysia: Current Trends and Future Prospects

Atrial fibrillation (AF) imposes substantial burdens of morbidity and impaired health-related quality of life, and significantly increases sufferers' risk of having a cardiovascular event, in particular a stroke. Prevalence of AF in Asia and the associated healthcare costs are likely to have been underestimated and are expected to increase due to greater awareness, population ageing and increasing prevalence of associated risk factors and comorbidities. The AF management paradigm is shifting from a conventional focus on achieving heart rate or rhythm control, towards endeavouring to use the safest agents available to reduce patients' symptoms and improve their quality of life and cardiovascular outcomes. No new anti-AF drugs have been introduced for decades and existing pharmacotherapeutic modalities have potentially serious side effects as well as sub-optimal efficacy in converting to and maintaining normal sinus rhythm and preventing recurrence. There is an unmet need for better anti-arrhythmic drugs that are well tolerated, efficacious, cost-effective and have a more favourable safety profile than current options. Although the perfect agent remains to be discovered, some promising new anti-arrhythmic drugs have the potential to overcome certain limitations of established approaches to AF management.