Current controversies in determining the main mechanisms of atrial fibrillation

Schotten, Ulrich; Dobrev, Dobromir; Platonov, Pyotr G.; Kottkamp, Hans; Hindricks, Gerhard

doi:10.1111/joim.12492

Cited by 81 publications

(53 citation statements)

References 66 publications

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“…Moreover, 20% of total strokes occur approximately in patients with this arrhythmia [3]. However, pathophysiological mechanisms causing and maintaining AF are still not completely understood [9]. This fact makes its diagnosis and therapy extremely challenging and, often, poorly efficient [10].…”

Section: Introductionmentioning

confidence: 99%

“…Indeed, recent studies point out that between 18 and 25% of patients evolve to permanent AF in less than 5 years [3]. Currently, it is also clinically accepted that AF causes electrophysiological 2 Complexity alterations in the atrial tissue to favor its maintenance [9]. Hence, the detection of AF signs as early as possible is essential to enable successful preventive therapies and, thus, to reduce its burden [15].…”

Section: Introductionmentioning

confidence: 99%

“…Their vast majority relies on quantifying the two significant alterations provoked by the arrhythmia on the ECG. Briefly, in contrast to sinus rhythm (SR), where the atria are contracted in response to a repetitive and synchronized electrical impulse originating at the sinus node, atrial contraction during AF is activated by very rapid and disorganized impulses generated at multiple locations [9]. This disorganized activation causes ineffective atrial contractions, such that the common P-waves in SR are replaced by irregular fibrillatory ( -) waves during AF [21].…”

Section: Introductionmentioning

confidence: 99%

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Combined Nonlinear Analysis of Atrial and Ventricular Series for Automated Screening of Atrial Fibrillation

et al. 2017

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Atrial fibrillation (AF) is the most common cardiac arrhythmia in clinical practice. It often starts with asymptomatic and short episodes, which are difficult to detect without the assistance of automatic monitoring tools. The vast majority of methods proposed for this purpose are based on quantifying the irregular ventricular response (i.e., RR series) during the arrhythmia. However, although AF totally alters the atrial activity (AA) reflected on the electrocardiogram (ECG), replacing stable P-waves by chaotic and time-variant fibrillatory waves, this information has still not been explored for automated screening of AF. Hence, a pioneering AF detector based on quantifying the variability over time of the AA morphological pattern is here proposed. Results from two public reference databases have proven that the proposed method outperforms current state-of-the-art algorithms, reporting accuracy higher than 90%. A less false positive rate in the presence of other arrhythmias different from AF was also noticed. Finally, the combination of this algorithm with the classical analysis of RR series variability also yielded a promising trade-off between AF accuracy and detection delay. Indeed, this combination provided similar accuracy than RR-based methods, but with a significantly shorter delay of 10 beats.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Combined Nonlinear Analysis of Atrial and Ventricular Series for Automated Screening of Atrial Fibrillation

et al. 2017

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“…15 A short atrial action potential facilitates both mechanisms, whereas slow conduction is a prerequisite for reentry. Thus, although some genes at the loci described by Christophersen et al, 6 such as SCN5A and TBX5, can be easily placed within this framework by virtue of their recognized role in mediating cardiac conduction, it is not surprising that for others their possible role is difficult to gather.…”

Section: Tadros Et Almentioning

confidence: 99%

Dissecting the Genetic Basis of the ECG as a Means of Understanding Mechanisms of Arrhythmia

Tadros

Coronel

Bezzina

2017

Circ Cardiovasc Genet

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T he surface ECG records the electrical potential of the heart at the surface of the body as the electrical impulse travels throughout the heart with each heartbeat. The P wave represents depolarization of the atria, which spreads from the sinoatrial node toward the atrioventricular node and from the right to the left atrium. The PR interval reflects the time the electrical impulse takes to travel from the sinus node through the atrioventricular node. The QRS complex represents the rapid depolarization of the ventricles, and the T wave represents the repolarization of the ventricles. See Article by Christophersen et alThe ECG is one of the most accessible and valuable diagnostic tests. It informs about the presence of cardiac chamber enlargement/hypertrophy, conduction disturbance, arrhythmia, myocardial infarction/ischemia, and even provides indications for electrolyte imbalance or drug intoxication. Since about a decade, researchers have turned to the ECG as a tool to dissect the genetic basis of cardiac electrical function with the idea that the biological processes that underlie or impinge on the different parameters of the ECG are mediators (intermediate phenotypes, endophenotypes) of arrhythmia risk.1 This concept, which in itself is clearly intuitive, is supported by population-based studies that demonstrated that ECG parameters are associated with risk of arrhythmia or sudden cardiac death.2 The approach is furthermore rationalized by the fact that ECG parameters have been shown to have a heritable component (reviewed in reference 3 ). The first ECG parameter that was studied in this way by the genome-wide association study (GWAS) approach was the QT interval 1 ; in fact the QT interval was one of the first traits to be studied at the outset of the GWAS era 10 years ago. 4 Facilitated by the availability of large cohorts with ECG recordings and the ability to measure ECG parameters reproducibly in an automated fashion, GWAS has since been applied to several ECG parameters in increasingly larger cohorts of individuals primarily of European descent with >150 loci being identified as modulators of these traits. 5In the current issue of Circulation: Cardiovascular Genetics, Christophersen et al 6 report findings from a GWAS that they conducted on parameters related to the P wave in 44 456 individuals originating from 12 cohort studies. These parameters were namely P wave duration, so far understudied by GWAS, and P wave terminal force, studied by GWAS for the first time. Concordant with the intermediate phenotype paradigm, and the relationship between these parameters and atrial electrophysiology 7 and risk for atrial fibrillation (AF), 8 these investigators posited that elucidating genetic variants related to these parameters will help in understanding atrial electrophysiology and possibly uncover genetic determinants and mechanisms of AF. The authors further postulate that this may in turn allow identification of new therapeutic targets for AF. They report 15 loci that include loci previously identified fo...

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“…In structurally abnormal hearts due to cardiovascular disease, hemodynamic stress and/or inflammatory processes result in Ca 2+ cycling protein, ion channel, structural, neural and vascular remodeling in the atria 44 . As a component of structural remodeling, fibrosis creates regions in which collagen bundles are interposed between strands of atrial myocytes (Fig.…”

Section: What Are the Challenges?mentioning

confidence: 99%

Ablating atrial fibrillation: A translational science perspective for clinicians

Weiss¹,

Qu²,

Shivkumar

2016

Heart Rhythm

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Although considerable progress has been made in developing ablation approaches to cure AF, outcomes are still suboptimal especially for persistent and long-lasting persistent AF. In this topical review, we review the arrhythmia mechanisms, both reentrant and non-reentrant, that are potentially relevant to human AF at various stages/settings. We describe arrhythmia mapping techniques used to distinguish between the different mechanisms, with a particular focus on the detection of rotors. We discuss which arrhythmia mechanisms are likely to respond to ablation, and the challenges and prospects for improving upon current ablation strategies to achieve better outcomes.

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Current controversies in determining the main mechanisms of atrial fibrillation

Abstract: Abstract. Schotten U, Dobrev D, Platonov PG, Kottkamp H, Hindricks G (Cardiovascular

Cited by 81 publications

References 66 publications

Combined Nonlinear Analysis of Atrial and Ventricular Series for Automated Screening of Atrial Fibrillation

Combined Nonlinear Analysis of Atrial and Ventricular Series for Automated Screening of Atrial Fibrillation

Dissecting the Genetic Basis of the ECG as a Means of Understanding Mechanisms of Arrhythmia

Ablating atrial fibrillation: A translational science perspective for clinicians

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