Atrial Fibrillation and Chronic Coronary Ischemia: A Challenging Vicious Circle

Abstract

Atrial fibrillation, the most frequent arrhythmia in clinical practice and chronic coronary syndrome, is one of the forms of coronary ischemia to have a strong dual relationship. Atrial fibrillation may accelerate atherosclerosis and may increase oxygen consumption in the myocardium, creating a mismatch between supply and demand, thus promoting the development or worsening of coronary ischemia. Chronic coronary syndrome alters the structure and function of gap junction proteins, affecting the conduction of action potential and leading to ischemic necrosis of cardiomyocytes and their replacement with fibrous tissue, in this way sustaining the focal ectopic activity in atrial myocardium. They have many risk factors in common, such as hypertension, obesity, type 2 diabetes mellitus, and dyslipidemia. It is vital for the prognosis of patients to break this vicious circle by controlling risk factors, drug therapies, of which antithrombotic therapy may sometimes be challenging in terms of prothrombotic and bleeding risk, and interventional therapies (revascularization and catheter ablation).

Global burden of atrial fibrillation/atrial flutter and its attributable risk factors from 1990 to 2021

“…Atrial fibrillation can exacerbate inflammatory responses, hastening atherosclerosis, while CHD heightens the risk of AF by enhancing focal ectopic activity in the left atrium and altering micro-re-entry patterns. 55 Prior studies reveal that CHD prevalence in AF patients ranges from 18% to 46.5%, acting as an independent risk factor for AF development. Moreover, AF frequently coincides with non-ST-segment elevation myocardial infarction (NSTEMI), with AF patients exhibiting a 39% higher risk of NSTEMI and double the likelihood of cardiovascular events or mortality compared with non-AF patients.…”

A Rare Case of Transient Mesenteric Ischemia After Atrial Fibrillation With Rapid Ventricular Response Rate

“…There is a large component of patients with embolic disease, such as atrial fibrillation who present with acute mesenteric ischemia. Atrial fibrillation is closely related to atherosclerosis and can compound ischemia through the vascular system by accelerating atherosclerosis, resulting in thrombus formation, with resultant embolization [ 3 - 4 ]. In these patients, especially those presenting a rapid ventricular response rate, it is important for rate control as well as anticoagulation.…”

An Overview of the Pharmacokinetics and Pharmacodynamics of Landiolol (an Ultra-Short Acting β1 Selective Antagonist) in Atrial Fibrillation

“…This required the study and development of a β-blocker such as landiolol, which has been primarily studied and utilized in the management of tachyarrhythmias, not only AF but also atrial flutter (AFL), because of its rapid onset and offset of action. In this way, it may be the best option for acute situations, where immediate HR control is required [ 1 , 2 , 3 , 4 , 5 , 6 , 7 ].…”

“…1 available for all beta-blockers. If: funny current; IKs: slow delayed rectifier potassium current; INa: sodium current; INaK: sodium-potassium pump current.…”