Amyloid deposition as a cause of atrial remodelling in persistent valvular atrial fibrillation

Abstract

Patients with long-standing AF and rheumatic heart disease have a very high prevalence of atrial amyloidosis. Amyloid deposition is more frequent in left than in right atrial appendage and correlates with AF duration and female gender. Amyloid deposition could constitute an additional histological feature in the structural remodeling of atria during long-standing AF, at least in rheumatic valve disease. Persistence of AF might play a pivotal role in promoting amyloid deposition.

The Association of Atrial Tachyarrhythmias with Isolated Atrial Amyloid Disease: Preliminary Observations in Autopsied Heart Specimens

“…With progressive amyloid deposition, apoptosis ensues and the atrial structure is disrupted [14]. Continued architectural distortion, as noted characteristically with atrial fibrosis in this and other diseases [15], predisposes to atrial electromechanical dysfunction and serves as a harbinger for atrial tachyarrhythmias, especially atrial fibrillation [6, 7, 16]. In addition, atrial ischemia and, in particular, vascular compromise to the areas perfusing the sinoatrial node and the Bachmann bundle (the principal interatrial conduction pathway) [8] may also play a key role [17, 18].…”

“…Leone et al [16] examined 66 left and 62 right atrial appendages from 72 patients with chronic persistent atrial fibrillation undergoing valvular heart surgery and 104 specimens from patients in sinus rhythm and observed that the incidence of IAA was higher in the left (45%) compared to the right atrial appendages (30%). They also observed that the sarcolemma of myocytes was predominantly involved rather than the endocardium, which was only sparsely affected.…”

2011 ACCF/AHA/HRS Focused Updates Incorporated Into the ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation

“…Autoimmune activity is suggested by high serum levels of antibodies against myosin heavy chains in patients with paroxysmal AF who have no identified heart disease. 72 Apart from fibrosis, atrial pathological findings in patients with AF include amyloidosis, 73,74 hemochromatosis, 75 and endomyocardial fibrosis. 75,76 Fibrosis is also triggered by atrial dilation in any type of heart disease associated with AF, including valvular disease, hypertension, HF, or coronary atherosclerosis.…”

Diagnosis and Management of the Cardiac Amyloidoses

“…121,122 Interestingly, an inverse relationship with the presence of atrial fibrosis has been suggested. 121,123 The role of isolated atrial amyloid in the pathogenesis and maintenance of atrial fibrillation remains to be fully elucidated, but it may be a precipitating factor of atrial fibrillation in some patients and may be produced as part of the remodeling associated with this arrhythmia.…”