Biomarkers and the prediction of atrial fibrillation: state of the art

Abstract

Atrial fibrillation (AF) is the most common sustained arrhythmia encountered in clinical practice, and it places a substantial burden on the health care system. Despite improvements in our understanding of AF pathophysiology, we have yet to develop targeted preventive therapies. Recently, numerous biological markers have been identified to aid in the prediction of future AF events. Subclinical markers of atrial stress, inflammation, endothelial dysfunction, kidney dysfunction, and atherosclerosis have been linked to AF. The connection between these markers and AF is the identification of subclinical states in which AF propagation is likely to occur, as these conditions are associated with abnormal atrial remodeling and fibrosis. Additionally, several risk scores have been developed to aid in the identification of at-risk patients. The practicing clinician should be aware of these subclinical markers, as several of these markers improve the predictive abilities of current AF risk scores. Knowledge of these subclinical markers also provides clinicians with a better understanding of AF risk factors, and the opportunity to reduce the occurrence of AF by incorporating well-known cardiovascular disease risk factor modification strategies. In this review, we highlight several novel biological markers that have improved our understanding of AF pathophysiology and appraise the utility of these markers to improve our ability to predict future AF events.

Atrial remodelling in heart failure: recent developments and relevance for heart failure with preserved ejection fraction

“…BNP54 and Galectin‐3120 have been shown to be markers of atrial remodelling and to directly correlate with the extent of LA fibrosis 121. Only recently has TNF‐alpha been suggested as a biomarker for increased fibrosis, cardiomyocyte apoptosis, and AF 122. Increases in TNF‐alpha are also associated with an increased risk of HF: in Framingham per tertile increment in TNF‐alpha, HF risk was increased by 68% 123, 124…”

“…121 Only recently has TNF-alpha been suggested as a biomarker for increased fibrosis, cardiomyocyte apoptosis, and AF. 122 Increases in TNF-alpha are also associated with an increased risk of HF: in Framingham per tertile increment in TNF-alpha, HF risk was increased by 68%. 123,124 Novel treatment approaches for atrial remodelling associated with HF have been tested in animal models.…”

Diabetes mellitus and atrial remodelling in patients with paroxysmal atrial fibrillation: Role of electroanatomical mapping and catheter ablation

“…33 Alterations of endothelial function predispose to AF by increasing atrial stretch, activation of inflammatory markers and favouring atrial fibrosis and AF development. 34 In this study, patients…”

P-Wave Area Predicts New Onset Atrial Fibrillation in Mitral Stenosis: A Machine Learning Approach

“…The association between IAB and supraventricular tachyarrhythmias, especially AF, is known as Bayés syndrome. Mitral stenosis is a major risk factor for AF through atrial dilatation with progressive structural remodeling and interstitial fibrosis, predisposing to re-entrant activity within the atrium (Markides and Schilling, 2003;O'neal et al, 2016). In addition to IAB, abnormal atrial electrophysiology can be detected by alterations in P-wave morphology on the electrocardiogram (ECG), including Pwave dispersion and abnormal P-wave terminal force in V1 (PTFV1) (Yamada et al, 1999;Dogan et al, 2004;Wong et al, 2004;Koide et al, 2008;Tsioufis et al, 2010;Yoshizawa et al, 2014).…”