Triggers and Anatomical Substrates in the Genesis and Perpetuation of Atrial Fibrillation

Author(s): Damian Sanchez-Quintana, Jose Ramon Lopez-Mínguez, Gonzalo Pizarro, Margarita Murillo, Jose Angel Cabrera.

Journal Name: Current Cardiology Reviews

Volume 8 , Issue 4 , 2012

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Abstract:

The definition of atrial fibrillation (AF) as a functional electrical disorder does not reflect the significant underlying structural abnormalities. Atrial and Pulmonary Vein (PV) muscle sleeve microstructural remodeling is present, and establishes a vulnerable substrate for AF maintenance. In spite of an incomplete understanding of the anatomo-functional basis for AF, current evidence demonstrates that this arrhythmia usually requires a trigger for initiation and a vulnerable electrophysiological and/or anatomical substrate for maintenance. It is still unclear whether the trigger mechanisms include focal enhanced automaticity, triggered activity and/or micro re-entry from myocardial tissue. Initiation of AF can be favored by both parasympathetic and sympathetic stimulation, which also seem to play a role in maintaining AF. Finally, evolving clinical evidence demonstrates that inflammation is associated with new-onset and recurrent AF through a mechanism that possibly involves cellular degeneration, apoptosis, and subsequent atrial fibrosis.

Keywords: Atrial fibrillation, triggers, pulmonary vein, structural remodeling

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Article Details

VOLUME: 8
ISSUE: 4
Year: 2012
Page: [310 - 326]
Pages: 17
DOI: 10.2174/157340312803760721
Price: $58

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