Atrial Myopathy Underlying Atrial Fibrillation

Abstract

While AF most often occurs in the setting of atrial disease, current assessment and treatment of patients with AF does not focus on the extent of the atrial myopathy that serves as the substrate for this arrhythmia. Atrial myopathy, in particular atrial fibrosis, may initiate a vicious cycle in which atrial myopathy leads to AF, which in turn leads to a worsening myopathy. Various techniques, including ECG, plasma biomarkers, electroanatomical voltage mapping, echocardiography, and cardiac MRI, can help to identify and quantify aspects of the atrial myopathy. Current therapies, such as catheter ablation, do not directly address the underlying atrial myopathy. There is emerging research showing that by targeting this myopathy we can help decrease the occurrence and burden of AF.

Novel diagnostic criteria for atrial cardiomyopathy in patients with type 2 diabetes and atrial fibrillation

“…Выделение данной патологии было вызвано с тем, что появились данные о неблагоприятном прогнозе при ее развитии как в отношении хронической сердечной недостаточности (ХСН), так и цереброваскулярных событий, особенно, в молодом возрасте при наличии генетических заболеваний [2]. Ряд авторов предполагают, что диагностика патологии сердечно-сосудистой системы на этапе развития ПКМП поможет рано увидеть проблему, что требует поиска лечебных вмешательств, способных предотвратить дальнейшее ее прогрессирование и неблагоприятные исходы [3,4].…”

Optimal Therapy for Stroke Prevention in Atrial Fibrillation: Is it Left Atrial Appendage Closure?

“…There is active current interest in defining the atrial myopathy or cardiopathy that is associated with stroke. [20][21][22] Several techniques have been under investigation, including LAA size/morphology, 23,24 electrocardiogram P wave morphology, 25,26 echocardiographic LA strain, 27,28 epicardial adipose tissue, 29 troponin and N terminal pro-brain natriuretic peptide levels 30,31 , and 4D flow MRI to evaluate left atrial and LAA stasis. [32][33][34] There is also ongoing research into "pill-in-pocket" anticoagulation that would use continuous smartwatch monitoring to target anticoagulation to intermediate risk patients during high risk time periods.…”

Impact of the Pattern of Atrial Fibrillation on Stroke Risk and Mortality

“…A consensus document and detailed reviews have discussed aspects of the definition, histopathology, atrial-specific physiology, atrial pathology, impact on arrhythmia occurrence, imaging, mapping, and ablation of the ACMP. [ 70 – 72 ]…”