Drivers of Atrial Fibrillation: Theoretical Considerations and Practical Concerns

Mann, Ian; Sandler, Belinda; Linton, Nick; Kanagaratnam, Prapa

doi:10.15420/aer.2017.40.3

Cited by 22 publications

(21 citation statements)

References 58 publications

(65 reference statements)

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“…The association of AF with the atrial Cx37 and Cx40 gene polymorphisms [35], as well as somatic mutations in GJA5 (encoding Cx40), have been identified in AF [36,37]. As a pulmonary veins isolation-based approach can resolve AF in 50%-70% of patients, it implies that other drivers of AF remain to be determined [38]. TH may be one of those drivers for AF.…”

Section: A Short Overview On Afmentioning

confidence: 99%

Pro-Arrhythmic Signaling of Thyroid Hormones and Its Relevance in Subclinical Hyperthyroidism

Tribulová

Kurahara

Hlivák

et al. 2020

IJMS

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A perennial task is to prevent the occurrence and/or recurrence of most frequent or life-threatening cardiac arrhythmias such as atrial fibrillation (AF) and ventricular fibrillation (VF). VF may be lethal in cases without an implantable cardioverter defibrillator or with failure of this device. Incidences of AF, even the asymptomatic ones, jeopardize the patient’s life due to its complication, notably the high risk of embolic stroke. Therefore, there has been a growing interest in subclinical AF screening and searching for novel electrophysiological and molecular markers. Considering the worldwide increase in cases of thyroid dysfunction and diseases, including thyroid carcinoma, we aimed to explore the implication of thyroid hormones in pro-arrhythmic signaling in the pathophysiological setting. The present review provides updated information about the impact of altered thyroid status on both the occurrence and recurrence of cardiac arrhythmias, predominantly AF. Moreover, it emphasizes the importance of both thyroid status monitoring and AF screening in the general population, as well as in patients with thyroid dysfunction and malignancies. Real-world data on early AF identification in relation to thyroid function are scarce. Even though symptomatic AF is rare in patients with thyroid malignancies, who are under thyroid suppressive therapy, clinicians should be aware of potential interaction with asymptomatic AF. It may prevent adverse consequences and improve the quality of life. This issue may be challenging for an updated registry of AF in clinical practice. Thyroid hormones should be considered a biomarker for cardiac arrhythmias screening and their tailored management because of their multifaceted cellular actions.

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Section: A Short Overview On Afmentioning

confidence: 99%

Pro-Arrhythmic Signaling of Thyroid Hormones and Its Relevance in Subclinical Hyperthyroidism

Tribulová

Kurahara

Hlivák

et al. 2020

IJMS

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“…81 Recent clinical review papers provide more details on electrical driver determination in AF. 82,83 Activation Versus Phase Mapping surface. We previously demonstrated that the spatial resolution of AF data can significantly affect the interpretation of the underlying AF mechanism, 84 which is a particularly important consideration when interpreting findings from low-resolution recording devices.…”

Section: Phase Mappingmentioning

confidence: 99%

“…[ 81 ] Recent clinical review papers provide more details on electrical driver determination in AF. [ 82 , 83 ]…”

Section: Cardiac Mapping Techniquesmentioning

confidence: 99%

Challenges Associated with Interpreting Mechanisms of AF

Roney

Wit

Peters

2020

Arrhythm Electrophysiol Rev

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Determining optimal treatment strategies for complex arrhythmogenesis in AF is confounded by the lack of consensus regarding the mechanisms causing AF. Studies report different mechanisms for AF, ranging from hierarchical drivers to anarchical multiple activation wavelets. Differences in the assessment of AF mechanisms are likely due to AF being recorded across diverse models using different investigational tools, spatial scales and clinical populations. The authors review different AF mechanisms, including anatomical and functional re-entry, hierarchical drivers and anarchical multiple wavelets. They then describe different cardiac mapping techniques and analysis tools, including activation mapping, phase mapping and fibrosis identification. They explain and review different data challenges, including differences between recording devices in spatial and temporal resolutions, spatial coverage and recording surface, and report clinical outcomes using different data modalities. They suggest future research directions for investigating the mechanisms underlying human AF.

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“…The proposed mechanisms of AF dating to the early 1900s include focal automaticity, organised re-entry or multiple re-entrant wavelets. [6][7][8][9] Technological advances since then have allowed us to better conceptualise these principles. Focal triggers and drivers within the pulmonary vein muscle sleeves and in the antral regions of the pulmonary veins have been found to be the predominant mechanism of paroxysmal AF and wide-area PVI has yielded favourable results in patients with paroxysmal AF.…”

Section: Af Mechanismsmentioning

confidence: 99%

“…Focal triggers and drivers within the pulmonary vein muscle sleeves and in the antral regions of the pulmonary veins have been found to be the predominant mechanism of paroxysmal AF and wide-area PVI has yielded favourable results in patients with paroxysmal AF. 10 In addition to the pulmonary veins, other areas identified to harbour focal drivers include the superior vena cava and the coronary sinus. 11 While focal triggers may be the dominant mechanism in paroxysmal AF, multiple mechanisms often coexist in patients with persistent AF, with variable mechanisms accounting for the initiation and perpetuation of AF.…”

Section: Af Mechanismsmentioning

confidence: 99%

Source Determination in Atrial Fibrillation

Latchamsetty

Morady

2018

Arrhythmia &Amp; Electrophysiology Review

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Techniques to ablate persistent atrial fibrillation (AF) continue to evolve. Recent technological and strategic innovations have included a focus on mapping and ablating AF sources. These attempts have not yet yielded a consistent improvement in clinical outcomes following AF ablation. Advancements in these techniques in the next few years, however, may enhance our ability to map and ablate AF as well as further our understanding of the mechanisms behind AF initiation, perpetuation, and recurrence.

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Drivers of Atrial Fibrillation: Theoretical Considerations and Practical Concerns

Cited by 22 publications

References 58 publications

Pro-Arrhythmic Signaling of Thyroid Hormones and Its Relevance in Subclinical Hyperthyroidism

Pro-Arrhythmic Signaling of Thyroid Hormones and Its Relevance in Subclinical Hyperthyroidism

Challenges Associated with Interpreting Mechanisms of AF

Source Determination in Atrial Fibrillation

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