Is left atrial fibrosis an independent determinant of atrial fibrillation in mitral stenosis?

Pawar, Prashant; Mumtaz, Zeeshan; Phadke, Milind; Bharati, Alpa; Mahajan, Ajay

doi:10.1016/j.ihj.2021.06.021

Cited by 1 publication

(1 citation statement)

References 13 publications

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“…Atrial arrhythmias are also common in patients with structurally abnormal hearts. Examples include mitral stenosis with a dilated left atrium [ 11 , 12 ] and atrial septal defect with increased volume load on the right atrium [ 13 - 16 ]. Dilatation of the atrial chamber and secondary modifications of the myocardial architecture of atrial conduction are the mechanisms that induce and sustain abnormal rhythms in these hearts.…”

Section: Introductionmentioning

confidence: 99%

Surgical and Electrical Anatomy of the Inter-Nodal and Intra-Atrial Conduction System in the Heart

et al. 2022

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An anatomical understanding of the atrial myocardium is crucial for surgeons and interventionists who treat atrial arrhythmias. We reviewed the anatomy of the inter-nodal and intra-atrial conduction systems. The anterior inter-nodal route (#1) arises from the sinus node and runs through the ventral wall of the atrial chambers. The major branch of route #1 approaches the atrioventricular node from the anterior aspect. Other branches of route #1 are Bachmann’s bundle and a vestibular branch around the tricuspid valve. The middle inter-nodal route (#2) begins with a broad span of fibers at the sinus venarum and extends to the superior limbus of the oval fossa. The major branch of route #2 joins with the branch of route #1 at the anterior part of the atrioventricular node. The posterior inter-nodal route (#3) is at the terminal crest and gives rise to many branches at the pectinate muscles of the right atrium and then approaches the posterior atrioventricular node after joining with the vestibular branch of route #1. The branches of the left part of Bachmann’s bundle and the branches of the second inter-nodal route form a thin myocardial network at the posterior wall of the left atrium. These anatomical structures could be categorized into major routes and side branches. There are 9 or more anatomical circles in the atrial chambers that could be structural sites for macro re-entry. The implications of normal and abnormal structures of the myocardium for the pathogenesis and treatment of atrial arrhythmias are discussed.

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