2
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      New concepts in atrial fibrillation pathophysiology Translated title: Neue Konzepte der Pathophysiologie von Vorhofflimmern

      review-article

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          The current classification of atrial fibrillation (AF) is mainly focused on the clinical presentation according to the duration of AF episodes and the mode of termination, which incompletely reflect the severity and progressive nature of the underlying atrial disease. In this review article, “atrial cardiomyopathy” is discussed as a new concept in AF pathophysiology. Electrogram-, imaging-, and biomarker-derived measures and parameters to assess atrial cardiomyopathy, which will likely impact how AF is clinically classified and managed in the future, are presented.

          Translated abstract

          Die aktuelle Klassifikation von Vorhofflimmern (VHF) basiert hauptsächlich auf der klinischen Präsentation unter Berücksichtigung der Dauer einzelner VHF-Episoden und der Art, wie eine VHF-Episode spontan endet. Dies beschreibt allerdings den Schweregrad und den progressiven Charakter der zugrunde liegenden atrialen Erkrankung nicht ausreichend. Im vorliegenden Übersichtsbeitrag wird die „atriale Kardiomyopathie“ als ein neues Konzept der Pathophysiologie von VHF diskutiert. Wir stellen elektrogramm-, bildgebungs- und biomarkerbasierte Parameter für die Beurteilung der atrialen Kardiomyopathie vor, die in der Zukunft wahrscheinlich die klinische Klassifikation und Behandlung von VHF beeinflussen werden.

          Related collections

          Most cited references17

          • Record: found
          • Abstract: not found
          • Article: not found

          OUP accepted manuscript

          (2020)
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Early Rhythm-Control Therapy in Patients with Atrial Fibrillation

            Despite improvements in the management of atrial fibrillation, patients with this condition remain at increased risk for cardiovascular complications. It is unclear whether early rhythm-control therapy can reduce this risk.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins.

              Atrial fibrillation, the most common sustained cardiac arrhythmia and a major cause of stroke, results from simultaneous reentrant wavelets. Its spontaneous initiation has not been studied. We studied 45 patients with frequent episodes of atrial fibrillation (mean [+/-SD] duration, 344+/-326 minutes per 24 hours) refractory to drug therapy. The spontaneous initiation of atrial fibrillation was mapped with the use of multielectrode catheters designed to record the earliest electrical activity preceding the onset of atrial fibrillation and associated atrial ectopic beats. The accuracy of the mapping was confirmed by the abrupt disappearance of triggering atrial ectopic beats after ablation with local radio-frequency energy. A single point of origin of atrial ectopic beats was identified in 29 patients, two points of origin were identified in 9 patients, and three or four points of origin were identified in 7 patients, for a total of 69 ectopic foci. Three foci were in the right atrium, 1 in the posterior left atrium, and 65 (94 percent) in the pulmonary veins (31 in the left superior, 17 in the right superior, 11 in the left inferior, and 6 in the right inferior pulmonary vein). The earliest activation was found to have occurred 2 to 4 cm inside the veins, marked by a local depolarization preceding the atrial ectopic beats on the surface electrocardiogram by 106+/-24 msec. Atrial fibrillation was initiated by a sudden burst of rapid depolarizations (340 per minute). A local depolarization could also be recognized during sinus rhythm and abolished by radiofrequency ablation. During a follow-up period of 8+/-6 months after ablation, 28 patients (62 percent) had no recurrence of atrial fibrillation. The pulmonary veins are an important source of ectopic beats, initiating frequent paroxysms of atrial fibrillation. These foci respond to treatment with radio-frequency ablation.
                Bookmark

                Author and article information

                Contributors
                dominik.linz@mumc.nl
                Journal
                Herzschrittmacherther Elektrophysiol
                Herzschrittmacherther Elektrophysiol
                Herzschrittmachertherapie & Elektrophysiologie
                Springer Medizin (Heidelberg )
                0938-7412
                1435-1544
                22 September 2022
                22 September 2022
                2022
                : 33
                : 4
                : 362-366
                Affiliations
                [1 ]GRID grid.5012.6, ISNI 0000 0001 0481 6099, Department of Physiology, CARIM School for Cardiovascular Diseases, , Maastricht University, Maastricht University Medical Center, ; Maastricht, The Netherlands
                [2 ]GRID grid.5012.6, ISNI 0000 0001 0481 6099, Department of Cardiology, , Maastricht University, Maastricht University Medical Center, ; 6202 AZ Maastricht, The Netherlands
                [3 ]GRID grid.10417.33, ISNI 0000 0004 0444 9382, Department of Cardiology, , Radboud University Medical Centre, ; Nijmegen, The Netherlands
                [4 ]GRID grid.1010.0, ISNI 0000 0004 1936 7304, Centre for Heart Rhythm Disorders, , University of Adelaide and Royal Adelaide Hospital, ; Adelaide, Australia
                [5 ]GRID grid.5254.6, ISNI 0000 0001 0674 042X, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, , University of Copenhagen, ; Copenhagen, Denmark
                Article
                897
                10.1007/s00399-022-00897-1
                9691491
                36136132
                4a20bf1b-eb47-4fe0-9b49-c84863285445
                © The Author(s) 2022

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 29 August 2022
                Categories
                Schwerpunkt
                Custom metadata
                © Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2022

                atrial fibrillation pathophysiology,atrial cardiomyopathy,imaging,electrogram,biomarkers,pathophysiologie von vorhofflimmern,atriale kardiomyopathie,bildgebung,elektrogramm,biomarker

                Comments

                Comment on this article