Bridging Clinical and Systems Perspectives on Atrial Fibrillation: Classification, Severity Assessment, and Multi-System Risk Factors

Abstract

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and a major contributor to morbidity, mortality, and healthcare burden worldwide. Traditional approaches to AF have primarily emphasized rhythm disturbance, yet growing evidence highlights the need for a multidimensional framework that integrates clinical presentation, disease severity, and systemic comorbidities. In this work, we propose an integrative perspective on AF that bridges clinical classification with systems-level risk assessment. We review established and emerging classification schemes, evaluate metrics for severity stratification, and highlight the role of multi-system contributors—including cardiovascular, metabolic, renal, and inflammatory pathways—in shaping disease progression and patient outcomes. By synthesizing clinical and systems perspectives, we aim to advance a holistic framework for risk stratification, guide personalized management strategies, and inform future research on AF as a complex, multi-organ syndrome. This integrative approach underscores the necessity of rethinking AF beyond rhythm control, emphasizing its systemic underpinnings and implications for healthcare delivery.