Electrophysiological Changes of the Atrium in Patients with Lone Paroxysmal Atrial Fibrillation

Centurión, Osmar Antonio; Isomoto, Shojiro; Shimizu, Akihiko

doi:10.4022/jafib.v1i12.566

Cited by 6 publications

(5 citation statements)

References 25 publications

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“…For example, in a recent study of 25 patients with paroxysmal lone AF, bi‐atrial abnormalities remote from arrhythmia (and thus very unlikely to result from AF‐induced remodelling) were documented, including conduction abnormalities, structural changes and sinus node dysfunction (96). More recently, one study of 58 lone AF patients also documented distinct abnormalities in atrial electrophysiological properties (97).…”

Section: Pathophysiology and Pathogenesis Of Lone Afmentioning

confidence: 99%

Lone atrial fibrillation: what is known and what is to come

Potpara

Lip

2011

International Journal of Clinical Practice

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Summary Atrial fibrillation (AF) is the most prevalent sustained cardiac arrhythmia in adults, affecting > 1% of general population. Atrial fibrillation is commonly associated with structural heart disease and is a major cause of significant cardiovascular morbidity and mortality. AF sometimes develops in a subset of young patients (e.g. aged ≤ 60 years), with no evidence of associated cardiopulmonary or other comorbid disease (including hypertension), and has been referred to as ‘lone AF’. The latter generally has a favourable prognosis; the prognostic and therapeutic implications of an accurate identification of patients with truly lone AF (that is, truly at low risk of complications), if any, would be of the utmost importance. The true prevalence of lone AF is unknown, varying between 1.6% and 30%, depending on the particular study population. Nonetheless, novel risk factors for AF, including obesity, metabolic syndrome, sleep apnea, alcohol consumption, endurance sports, anger, hostility, subclinical atherosclerosis and others, have been increasingly recognised. Also, various underlying pathophysiological mechanisms predisposing to AF, including increased atrial stretch, structural and electrophysiological alterations, autonomic imbalance, systemic inflammation, oxidative stress and genetic predisposition, have been proposed. The growing evidence of these diverse (and numerous) pathogenic mechanisms and factors related to AF inevitably raises the question of whether ‘lone AF’ does exist at all. In this review article, we summarise the current knowledge of the epidemiology, pathophysiology, clinical course and treatment of patients with so‐called ‘lone AF’ and outline emerging insights into its pathogenesis and the potential therapeutic implications of a diagnosis of lone AF.

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Section: Pathophysiology and Pathogenesis Of Lone Afmentioning

confidence: 99%

Lone atrial fibrillation: what is known and what is to come

Potpara

Lip

2011

International Journal of Clinical Practice

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“…This irregularity is characterized by a non-homogeneous local electrical activity, related to an anisotropic, non-uniform and delayed conduction through a pathological atrial myocardium. [16][17][18] In such altered atrial substrate arrhythmias may develop due to reentry. The 3D electroanatomic mapping (EAM) revealed anatomic and structural atrial abnormalities that were associated with a change in the nature of sinus pacemaker activity.…”

Section: Introductionmentioning

confidence: 99%

The association of low voltage atrial electrograms and the myocardial substrate for atrial fibrillation

Centurión¹,

Alderete²,

Candia³

et al. 2019

JCCR

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Abnormal human atrial muscle has elevated resting membrane potential, depressed maximal amplitude of the action potential, and decreased upstroke velocity. These electrical abnormalities are histologically correlated to degenerative changes of the atrial muscle structure. Investigations based on the recording of abnormally prolonged and fractionated atrial endocardial electrograms during sinus rhythm have provided important knowledge about the electrophysiological properties of the pathological atrium. Human atrial tissues, where fractionated electrograms are recorded, consist of muscle fibers that are widely separated and their orientation distorted by connective tissue. These histological changes results in decreased intercellular connections, which might increase resistance to current flow, and thereby slow conduction. The potential clinical significance is that detection of abnormal atrial endocardial electrograms during sinus rhythm in patients with atrial vulnerability may help to identify those with greater atrial conduction defects and higher incidence of induced and spontaneous episodes of AF. 3D electroanatomic mapping (EAM) has been utilized in clinical electrophysiological studies for substrate description in atrial arrhythmias. Using this 3D EAM system low bipolar endocardial voltage can be identified and localized for guiding catheter ablation. Voltage mapping with 3D electroanatomic mapping is based on the correlation of the registration of low-voltage areas (<0.5 mV) in the left atrium with endocardial scar and/or structural defects as an atrial substrate. These low-voltage zones are the target for individualized substrate ablation or modification. Patients with low-voltage substrate have lower success rates after pulmonary vein ablation. However, this low success rate can be significantly improved by targeting atrial substrate zones with low voltage areas. Although more clinical evidence should be further generated, patient specific substrate ablation targeting atrial fibrosis estimated by bipolar voltage mapping is a promising alternative strategy for additional substrate modification beyond PVI ablation for AF. [1][2][3][4][5][6]

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“…Despite the good clinical results obtained with conventional pharmacological agents and different new drugs, the optimal medical treatment can fail in the intention to improve symptoms and quality of life of HF patients with severe left ventricular dysfunction and AF with uncontrolled ventricular rate [21][22][23][24] . Therefore, the necessity to utilize cardiac devices to perform biventricular pacing, or the need to use catheter ablation, or both, emerges facing the failure of optimal medical treatment in order to achieve hemodynamic improvement and correction of the physio-pathological alterations.…”

Section: Introductionmentioning

confidence: 99%

Atrioventricular Nodal Catheter Ablation in Atrial Fibrillation Complicating Congestive Heart Failure

Centurión¹

2018

Journal of Atrial Fibrillation

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The development of atrial fibrillation (AF) during the course of the evolution of heart failure (HF) worsens the clinical outcomes and the prognosis accounting for an enormous economic burden on healthcare. AF is considered to be an independent predictor of morbidity and mortality increasing the risk of death and hospitalization in 76% in HF patients. Despite the good clinical results obtained with conventional pharmacological agents and different new drugs, the optimal medical treatment can fail in the intention to improve symptoms and quality of life of HF patients with severe left ventricular dysfunction and AF with uncontrolled ventricular rate. Therefore, the necessity to utilize cardiac devices to perform cardiac resynchronization therapy (CRT), or the need to use catheter ablation, or both, emerges facing the failure of optimal medical treatment in order to achieve hemodynamic improvement. Some of these AF patients will require atrio-ventricular nodal (AVN) catheter ablation in order to restore 100% CRT functionality and improvements in clinical outcomes. It is hard to imagine that the deliberate destruction of a natural and normally functional specialized tissue of the main conduction system of the heart would do any good. However, in the presence of AF with rapid ventricular response due to normal conduction through the AV node in HF patients, the fast ventricular rate can cause deleterious consequences in the clinical outcome. Moreover, there are interesting published data which will be analyzed in this manuscript documenting significant acute and long-term improvement in left ventricular function, symptoms, exercise tolerance, clinical outcomes, and quality of life in selected HF patients with paroxysmal and persistent drug-refractory AF who have undergone AVN ablation and permanent pacemaker implantation.

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Electrophysiological Changes of the Atrium in Patients with Lone Paroxysmal Atrial Fibrillation

Cited by 6 publications

References 25 publications

Lone atrial fibrillation: what is known and what is to come

Lone atrial fibrillation: what is known and what is to come

The association of low voltage atrial electrograms and the myocardial substrate for atrial fibrillation

Atrioventricular Nodal Catheter Ablation in Atrial Fibrillation Complicating Congestive Heart Failure

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