Format

Send to

Choose Destination
Eur Heart J. 2016 May 21;37(20):1573-81. doi: 10.1093/eurheartj/ehv375. Epub 2015 Nov 17.

Novel mechanisms in the pathogenesis of atrial fibrillation: practical applications.

Author information

1
Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.
2
Department of Physiology, Maastricht University, Maastricht, The Netherlands.
3
Adelaide Institute for Sleep Health, Repatriation General Hospital and Department of Medicine, Flinders University, Adelaide, Australia.
4
Department of Cardiology, Assistance Publique - Hôpitaux de Paris, Pitié-Salpêtrière Hospital and Institute of Cardiometabolism and Nutrition, Sorbonne Université, INSERM UMR S1166, Paris, France.
5
Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
6
Department of Cardiology, Royal Melbourne Hospital and the Department of Medicine, University of Melbourne, Melbourne, Australia.
7
Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia prash.sanders@adelaide.edu.au.

Abstract

Intensive research over the last few decades has seen significant advances in our understanding of the complex mechanisms underlying atrial fibrillation (AF). The epidemic of AF and related hospitalizations has been described as a 'rising tide' with estimates of the global AF burden showing no sign of retreat. There is urgency for effective translational programs in this field to facilitate more individualized and targeted therapy to modify the abnormal atrial substrate responsible for the perpetuation of this arrhythmia. In this review, we chose to focus on several novel aspects of AF pathogenesis whereby practical applications in clinical practice are currently available or potentially not too far away. Specifically, we explored the contribution of atrial fibrosis, epicardial adipose tissue, autonomic nervous system, hyper-coagulability, and focal drivers to adverse atrial remodelling and AF persistence. We also highlighted the potential practical means of monitoring and targeting these factors to achieve better outcomes in patients suffering from this debilitating illness. Emerging data also support a new paradigm for targeting AF substrate with aggressive risk factor management. Finally, multi-disciplinary integrated care approach has shown great promise in improving cardiovascular outcomes of patients with AF along with potential cost savings.

KEYWORDS:

Atrial fibrillation; Integrated care; Mechanisms; Pathogenesis; Risk factor management; Substrate

PMID:
26578197
DOI:
10.1093/eurheartj/ehv375
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Silverchair Information Systems
Loading ...
Support Center