(Circulation. 2001;103:769.)
© 2001 American Heart Association, Inc.
Current Perspective |
Pathophysiology and Prevention of Atrial Fibrillation
From the University of Limberg, Maastricht, the Netherlands (M.A.A.); the College of Physicians and Surgeons of Columbia University, Department of Pharmacology, New York, NY (P.A.B., M.J. Legato, M.R.R.); St George’s Hospital, London, England (A.J.C.); University of Bern, Bern, Switzerland (A.G.K.); Imperial College School of Medicine, London, England (M.J. Lab); University of Pavia, Pavia, Italy (P.J.S.); National Heart, Lung, and Blood Institute, Bethesda, Md (P.M.S.); Cleveland Clinic Foundation, Cleveland, Ohio (D.R.V.W.); and Case Western Reserve University, Cleveland, Ohio (A.L.W.).
Correspondence to Michael R. Rosen, MD, Gustavus A. Pfeiffer Professor of Pharmacology, Professor of Pediatrics, College of Physicians & Surgeons of Columbia University, Department of Pharmacology, 630 W 168 St, PH7W-321, New York, NY 10032. E-mail mrr1@columbia.edu
Key Words: risk factors • atrial fibrillation • prevention
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Introduction |
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Atrial fibrillation (AF) is a ubiquitous yet diverse cardiac arrhythmia whose incidence increases with age; with most forms of cardiac and some pulmonary diseases; and with a number of metabolic, toxic, endocrine, or genetic abnormalities.1 2 Classification of clinical AF subtypes can be achieved on the basis of the ease by which episodes of the arrhythmia terminate as follows3 : "Paroxysmal" AF refers to episodes that generally stop spontaneously after no more than a few days. "Persistent" AF occurs less frequently than paroxysmal AF and, rather than self-terminating, requires cardioversion to restore sinus rhythm. "Permanent" AF cannot be converted to sinus rhythm. These terms apply strictly to chronic AF, because a single episode of the arrhythmia cannot be fully categorized. Although there are some mixed patterns, they generally derive from physician impatience for early cardioversion or from pragmatic clinical considerations (eg, to avoid thrombus formation or hemodynamic decompensation).
Patients initially presenting with paroxysmal AF often progress to longer, non–self-terminating bouts. An exception may be paroxysmal AF during intense vagotonia. Moreover, AF initially responsive to pharmacological or electrical cardioversion tends to become resistant and cannot then be converted to sinus rhythm. To some extent, the failure of the physician to suggest or the patient to accept further cardioversion attempts may lead to diagnosis of "permanent" AF. Thus, the "point of no return" may be determined by true pathophysiological abnormalities or may merely be an artifact of clinical pragmatism.
Effective prevention is essential in managing this
arrhythmia whose occurrence is widespread, progression is
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A. Burashnikov and C. Antzelevitch Reinduction of Atrial Fibrillation Immediately After Termination of the Arrhythmia Is Mediated by Late Phase 3 Early Afterdepolarization-Induced Triggered Activity Circulation, May 13, 2003; 107(18): 2355 - 2360. [Abstract] [Full Text] [PDF]
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H. Sinno, K. Derakhchan, D. Libersan, Y. Merhi, T. K. Leung, and S. Nattel Atrial Ischemia Promotes Atrial Fibrillation in Dogs Circulation, April 15, 2003; 107(14): 1930 - 1936. [Abstract] [Full Text] [PDF]
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T. V. Glotzer, A. S. Hellkamp, J. Zimmerman, M. O. Sweeney, R. Yee, R. Marinchak, J. Cook, A. Paraschos, J. Love, G. Radoslovich, et al. Atrial High Rate Episodes Detected by Pacemaker Diagnostics Predict Death and Stroke: Report of the Atrial Diagnostics Ancillary Study of the MOde Selection Trial (MOST) Circulation, April 1, 2003; 107(12): 1614 - 1619. [Abstract] [Full Text] [PDF]
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R. F. Bosch, C. R. Scherer, N. Rub, S. Wohrl, K. Steinmeyer, H. Haase, A. E. Busch, L. Seipel, and V. Kuhlkamp Molecular mechanisms of early electrical remodeling: transcriptional downregulation of ion channel subunits reduces ICa,L and Ito in rapid atrial pacing in rabbits J. Am. Coll. Cardiol., March 5, 2003; 41(5): 858 - 869. [Abstract] [Full Text] [PDF]
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I. Savelieva and A. John Camm Atrial fibrillation and heart failure: natural history and pharmacological treatment Europace, January 1, 2003; 5(s1): S5 - S19. [Abstract] [Full Text] [PDF]
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M. R. Rosen Blunderbuss to Mickey Mouse: The Evolution of Antiarrhythmic Targets Circulation, September 3, 2002; 106(10): 1180 - 1182. [Full Text] [PDF]
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H. Oral, B. P. Knight, M. Ozaydin, A. Chugh, S. W.K. Lai, C. Scharf, S. Hassan, R. Greenstein, J. D. Han, F. Pelosi Jr, et al. Segmental Ostial Ablation to Isolate the Pulmonary Veins During Atrial Fibrillation: Feasibility and Mechanistic Insights Circulation, September 3, 2002; 106(10): 1256 - 1262. [Abstract] [Full Text] [PDF]
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B. Freestone, G. Y.H. Lip, S. E. Vermeer, A. Hofman, M. M.B. Breteler, and P. J. Koudstaal Prevalence and Risk Factors of Silent Brain Infarcts in the Population Stroke, May 1, 2002; 33(5): 1179 - 1180. [Full Text] [PDF]
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S. Nattel, M. Allessie, and M. Haissaguerre Spotlight on atrial fibrillation--the 'complete arrhythmia' Cardiovasc Res, May 1, 2002; 54(2): 197 - 203. [Full Text] [PDF]
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R. F Bosch and S. Nattel Cellular electrophysiology of atrial fibrillation Cardiovasc Res, May 1, 2002; 54(2): 259 - 269. [Full Text] [PDF]
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P.-S. Chen, T.-J. Wu, C. Hwang, S. Zhou, Y. Okuyama, A. Hamabe, Y. Miyauchi, C.-M. Chang, L. S. Chen, M. C. Fishbein, et al. Thoracic veins and the mechanisms of non-paroxysmal atrial fibrillation Cardiovasc Res, May 1, 2002; 54(2): 295 - 301. [Abstract] [Full Text] [PDF]
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B. J.J.M. Brundel, R. H. Henning, H. H. Kampinga, I. C. Van Gelder, and H. J.G.M. Crijns Molecular mechanisms of remodeling in human atrial fibrillation Cardiovasc Res, May 1, 2002; 54(2): 315 - 324. [Abstract] [Full Text] [PDF]
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P. Jais, R. Weerasooriya, D. C. Shah, M. Hocini, L. Macle, K.-J. Choi, C. Scavee, M. Haissaguerre, and J. Clementy Ablation therapy for atrial fibrillation (AF): Past, present and future Cardiovasc Res, May 1, 2002; 54(2): 337 - 346. [Abstract] [Full Text] [PDF]
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S. Kostin, G. Klein, Z. Szalay, S. Hein, E. P Bauer, and J. Schaper Structural correlate of atrial fibrillation in human patients Cardiovasc Res, May 1, 2002; 54(2): 361 - 379. [Abstract] [Full Text] [PDF]
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T. Yagi, J. Pu, P. Chandra, M. Hara, P. Danilo Jr., M. R Rosen, and P. A Boyden Density and function of inward currents in right atrial cells from chronically fibrillating canine atria Cardiovasc Res, May 1, 2002; 54(2): 405 - 415. [Abstract] [Full Text] [PDF]
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A. P. Moreno, M. Chanson, J. Anumonwo, I. Scerri, H. Gu, S. M. Taffet, and M. Delmar Role of the Carboxyl Terminal of Connexin43 in Transjunctional Fast Voltage Gating Circ. Res., March 8, 2002; 90(4): 450 - 457. [Abstract] [Full Text] [PDF]
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Members of the Sicilian Gambit New Approaches to Antiarrhythmic Therapy, Part I: Emerging Therapeutic Applications of the Cell Biology of Cardiac Arrhythmias Circulation, December 4, 2001; 104(23): 2865 - 2873. [Abstract] [Full Text] [PDF]
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Members of the Sicilian Gambit New approaches to antiarrhythmic therapy; emerging therapeutic applications of the cell biology of cardiac arrhythmias Eur. Heart J., December 1, 2001; 22(23): 2148 - 2163. [Abstract] [PDF]
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