Katarína Hatalová
„Upstream“ therapy of patients with atrial fibrillation is defined as administration of non-arrhythmic drugs aimed at prevention of both new-onset and recurrent atrial fibrillation (AF). It is based on effects of these drugs beyond their conventional indications. These effects are aimed on prevention and, if possible, reversal of structural and electrical remodelling of the atrial myocardium. RAAS inhibitors, statins and n-3 PUFAs have demonstrated efficacy in primary prevention of AF and their administration became an integral part of the new ESC guidelines for management of AF. However, the clinical efficacy of this approach can only by expected with therapy initiation early in the course of the disease, before substantial atrial remodelling has occurred. Advanced atrial remodelling cannot be substantially influenced by this therapeutic approach.