Emerging biomarkers for improved risk prediction of atrial fibrillation: potential role of bone morphogenic protein 10

Atrial fibrillation (AF) is the most common cardiac arrhythmia.Although per se not immediately life-threatening, the adverse outcomes of AF encompass reduced exercise capacity, development of heart failure, thromboembolism and ischemic stroke, as well as depression and cognitive impairment.The most important risk factors for AF manifestation and progression to persistent forms are age and comorbidities like hypertension, coronary artery disease, valvular heart disease, chronic kidney disease and metabolic syndrome.These diseases promote maladaptive structural and functional remodeling as well as inflammation of the atrial myocardium, conceptually bundled by the term atrial cardiomyopathy (AtCM) (1).To date, there is no established clinical definition of AtCM, although tangible diagnostic criteria have been proposed.Also, the mechanistic and temporal nature of the interaction between comorbidities, AtCM and AF remains unclear.While AF is either present or not at a given timepoint, the quality and extent of the underlying AtCM may substantially vary over time.In addition, another big challenge is the integration of the novel concept of AF burden into the framework of AtCM, which requires a proper search for and monitoring of AF (1, 2).