Atrial fibrillation is one of the most common clinical arrhythmias. The following is a brief description of the most representative issues of concern to patients, in the hope that it will be helpful to the majority of patients. 1.Why do you get atrial fibrillation? Atrial fibrillation is, in the end, an abnormal electrical activity in the atria due to various causes of fibrosis, and, due to anatomical characteristics, the majority of them occur in the left atrium. The occurrence of atrial fibrillation mostly undergoes a developmental process of atrial precontraction (premature atrial beats) – atrial velocity – atrial flutter – paroxysmal atrial fibrillation – sustained atrial fibrillation. Of course, the progression of this process varies from person to person; some people may take decades, while others may reach the stage of persistent AF within a short period of time. Overall, everyone has the potential to develop AF if they live a long enough life. There are many causes of atrial fibrillation, including genetic variants, hyperthyroidism, coronary artery disease, hypertension, diabetes, cardiomyopathy, and other diseases. Chronic alcohol consumption, overexertion, and smoking are also common causes. Some patients will have attacks at a younger age, the youngest even in their teens. Generally speaking, the earlier the onset, the greater the relationship with genetic mutations. In recent years, atrial fibrillation caused by chronic alcohol abuse has become increasingly common, and this type of atrial fibrillation is more difficult to treat. Most patients with atrial fibrillation often do not have a single clear clinical cause, a condition we call idiopathic atrial fibrillation. Some patients will develop atrial fibrillation early after undergoing cardiac surgery, but this atrial fibrillation is often caused by heart surgery, and may disappear for a long time afterwards without further attacks. 2. What are the symptoms and dangers of atrial fibrillation? The symptoms of atrial fibrillation vary from person to person. The most common is panic and heartbeat, while some people may feel tightness in the chest, shortness of breath or sweating. Some people will have polyuria, followed by a longer period of self-conscious weakness due to low potassium. However, these symptoms are highly variable, and many people tend to have symptoms this episode and then seem to be less pronounced the next time, or even some people (especially men) only find atrial fibrillation by chance during a routine physical exam or a visit for another condition. A more common type of atrial fibrillation is a slow heartbeat, but a fast heartbeat during an atrial fibrillation attack, which we call slow-fast syndrome. The reason for this is that there are two atria: the right atrium has the sinus node, which is responsible for the normal heartbeat, and if there is a fibrotic lesion in the right atrium, it leads to a decrease in the function of the sinus node and sinus bradycardia or sinus arrest, while a fibrotic lesion in the left atrium leads to atrial tachycardia, atrial flutter and atrial fibrillation. Most patients have atrial fibrillation that tends to flare up after exertion, alcohol consumption, and at night, but this attack pattern is usually not fixed and is not important for diagnostic treatment. Some patients think that the trigger and regularity of the onset is important, but in fact it is not very significant for treatment. 3, how to diagnose atrial fibrillation? The diagnosis of atrial fibrillation is very easy, as long as the attack is captured by a general ECG or an ambulatory ECG to confirm the diagnosis, no special tests are needed. However, cardiac ultrasound, ECG and blood tests can be done to find out if other conditions are combined. If atrial fibrillation starts and stops on its own without medication, it is called paroxysmal atrial fibrillation, and if the attack cannot be stopped without medication or even if medication is ineffective, it is called persistent atrial fibrillation. If it lasts for a long time and cannot be reversed even with drugs and electrical resuscitation, it is called permanent atrial fibrillation. 4.What medications are used to treat atrial fibrillation? The treatment of atrial fibrillation is a difficult problem. First, you should try to control it with medication. You need to be guided by your doctor to find a medication that is right for you. However, it must be clear that, at present, no medication can eradicate atrial fibrillation, except for the few atrial fibrillation caused by hyperthyroidism or, pre-excitation syndrome, early post-operative cardiac surgery, etc., which may not recur after these conditions are resolved. However, medications may indeed make some others seizure-free or almost seizure-free for a considerable period of time. However, the atrial fibrillation lesion is still present and will continue to develop, and sooner or later another attack may occur. Therefore, for atrial fibrillation, the use of drugs is equivalent to “stabilization”, and some patients with mild symptoms, low risk of stroke, few attacks or advanced age, frail health, combined with other serious diseases and poor economic conditions, can choose conservative treatment with drugs. 5.What is catheter ablation for atrial fibrillation? How about cryoablation? Catheter ablation for atrial fibrillation is a technique that has gained popularity in the last decade or so. In general, it is a safe and minimally invasive interventional treatment. However, unfortunately, the results of the current treatment are not particularly satisfactory. It is performed by delivering a catheter into the heart through a vascular puncture to destroy the lesion causing atrial fibrillation and achieve the goal of treatment. The surgical procedure has evolved several times, with the pulmonary vein large-loop isolation currently being the mainstay, but its drawbacks have been increasingly identified, mainly the difficulty in breaking the bottleneck in terms of success rate and worse long-term results. In paroxysmal atrial fibrillation, in general, the earlier the treatment, the better the outcome, but some patients may have severe atrial lesions soon after the onset. In the long term, the results of the current mainstream pulmonary vein isolation are not particularly satisfactory, especially in persistent atrial fibrillation, where the success rate over 5 years is currently reported abroad to be between 15-50% if a single ablation procedure is performed, and, moreover, the former is more plausible. Our long term success rate of linear ablation using special techniques is among the international leaders, but for persistent atrial fibrillation, complete cure after 5 years with a single procedure is only close to 50%, and other patients can only achieve improvement.