Individualized therapy in patients with atrial fibrillation: new look at atrial fibrillation

Abstract

Atrial fibrillation (AF) is the most common sustained arrhythmia and is associated with significant morbidity and mortality, the so-called AF burden. Despite significant progress in the understanding, the mechanisms and pathophysiology of AF treatments are often unsatisfactory. This in part may be related to the complexity of this arrhythmia, as well as its evolution overtime. Atrial fibrillation has many aetiologies and underlying causes. The anti-arrhythmic drugs (AADs) and interventions aimed at controlling AF should therefore be based on aetiology and associated conditions, rather than electrophysiological mechanisms. The current guideline in the management of AF in most part is based on safety and outcome. This review will discuss the approach to management, based on primary prevention of AF with the aim to target at risk factors, triggers, specific substrates related to aetiology rather than mechanisms. The development of new pharmacological agents and therapeutic strategies should consider not only evidence based, but also include patient-specific personalized context system biology and pharmacology; otherwise, we will continue to see moderate drug efficacy at best and negative results and outcomes.

The role of atherosclerotic coronary arteries lesions in development of new-onset atrial fibrillation after coronary artery bypass surgery

“…Ишемическая болезнь сердца (ИБС) является лидирующей причиной смертности трудоспособного на се ле ния большинства стран мира, она увеличивает риск развития ФП в 4-5 раз, несмотря на активное развитие возможностей медикаментозной терапии [3,4]. Атеросклеротическое поражение коронарных артерий процесс длительный и прогрессирующий, при-водящий к нарушению кровообращения и ишемическому повреждению участков миокарда, которые ответственны за биоэлектрическую активность сердца.…”

“…Одним из возможных механизмов формирования новых множественных диффузно расположенных аритмогенных очагов в ЛП может быть хроническая гипоксия, вызванная атеросклеротическим поражением ветви ЛП. Длительная ишемия приводит к морфологическим изменениям: эндогенному воспалению, и как следствие -фиброзу миокарда и ремоделированию ЛП [4].…”

A novel treatment strategy of new onset atrial fibrillation after cardiac surgery: an observational prospective study

“…Furthermore, it may contribute to longer hospital stays which can be associated with deterioration in heart failure, prolonged inotropic support, use of intraaortic balloon pump, and increased risk for cerebrovascular accidents [3,4]. After more than a century of research, the etiology and pathophysiology of this arrhythmia is still not completely understood [2,5]. In terms of treatment, there are several drugs, such as digitalis, Beta-blockers, calcium channel-blockers, and pharmacological or electrical cardioversion (EC), which were shown as efficient treatment strategies of AF in patients undergoing cardiac surgery [6].…”