Lymphomonomuclear infiltration and elevated fibrosis extent in the right and left ventricular myocardium is linked to histology of Bachman bundle and associated with history of atrial fibrillation

Mitrofanova, Lubov; Orshankaya, V.; Ho, Siew Yen; Platonov, P. G.

doi:10.1093/eurheartj/eht310.p5041

Cited by 3 publications

(5 citation statements)

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“…There is also evidence for the potential contribution of atrial fibrosis in pAF patients [35,45]. Compared to patients in sinus rhythm, pAF patients displayed atrial fibrosis in the area of crista terminalis [35,45] and the inferior pulmonary veins (PV) [35]. Similar trends were observed in the Bachman's Bundle and left atrium, albeit no significant differences were found in these regions [35,45].…”

Section: Fundamental Mechanism Of Pafmentioning

confidence: 92%

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Emerging Antiarrhythmic Drugs for Atrial Fibrillation

Saljic

Heijman

Dobrev

2022

IJMS

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Atrial fibrillation (AF), the most common cardiac arrhythmia worldwide, is driven by complex mechanisms that differ between subgroups of patients. This complexity is apparent from the different forms in which AF presents itself (post-operative, paroxysmal and persistent), each with heterogeneous patterns and variable progression. Our current understanding of the mechanisms responsible for initiation, maintenance and progression of the different forms of AF has increased significantly in recent years. Nevertheless, antiarrhythmic drugs for the management of AF have not been developed based on the underlying arrhythmia mechanisms and none of the currently used drugs were specifically developed to target AF. With the increased knowledge on the mechanisms underlying different forms of AF, new opportunities for developing more effective and safer AF therapies are emerging. In this review, we provide an overview of potential novel antiarrhythmic approaches based on the underlying mechanisms of AF, focusing both on the development of novel antiarrhythmic agents and on the possibility of repurposing already marketed drugs. In addition, we discuss the opportunity of targeting some of the key players involved in the underlying AF mechanisms, such as ryanodine receptor type-2 (RyR2) channels and atrial-selective K+-currents (IK2P and ISK) for antiarrhythmic therapy. In addition, we highlight the opportunities for targeting components of inflammatory signaling (e.g., the NLRP3-inflammasome) and upstream mechanisms targeting fibroblast function to prevent structural remodeling and progression of AF. Finally, we critically appraise emerging antiarrhythmic drug principles and future directions for antiarrhythmic drug development, as well as their potential for improving AF management.

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Section: Fundamental Mechanism Of Pafmentioning

confidence: 92%

Section: Fundamental Mechanism Of Pafmentioning

confidence: 99%

Emerging Antiarrhythmic Drugs for Atrial Fibrillation

Saljic

Heijman

Dobrev

2022

IJMS

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“… 70 In comparison to the other components, the posterior wall has a greater level of fibrous-fatty involvement. 71 Due to the interplay between myofibroblasts and myocytes, this structural component of the left atrial posterior wall also triggers AF episodes. 72 Therefore, the posterior wall is both a perpetuator and source of AF triggers, and its ablation offers a logical method of rhythm management for all AF forms.…”

Section: Catheter Ablation Strategies Beyond Pvimentioning

confidence: 99%

Catheter Ablation Approaches for the Treatment of Arrhythmia Recurrence in Patients with a Durable Pulmonary Vein Isolation

Nesapiragasan,

Hayıroğlu,

Sciacca

et al. 2023

Balkan Med J

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Catheter ablation has emerged as an effective treatment for atrial arrhythmias, and pulmonary vein isolation (PVI) is the cornerstone of ablation strategies. Significant technological evolution and widespread increase in operator experience have facilitated the effectiveness of catheter ablation to achieve durable PVIs in single or multiple ablation procedures. Nevertheless, arrhythmia recurrence is a common problem even after establishing PVI. Data on catheter ablation in these patients are sparse and repeat ablation in this population is highly challenging. In this review we have summarized the available data as well as potential strategies of catheter ablation following the initial PVI.

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“…47 Furthermore, compared with other structures, the degree of fibrofatty infiltration is higher in PW, which may result in the formation of an arrhythmogenic substrate. 48 Considering all these histological, anatomical, and physiological features, PW is not only a triggering source of AF but also plays a role in the maintenance of AF. Therefore, PW isolation (PWi), in addition to PVI, seems to be a rational approach for rhythm control.…”

Section: Posterior Wallmentioning

confidence: 99%

“…Anatomically, PW has a heterogeneous fiber orientation, which may trigger anisotropy and reentry formation 47 . Furthermore, compared with other structures, the degree of fibrofatty infiltration is higher in PW, which may result in the formation of an arrhythmogenic substrate 48 . Considering all these histological, anatomical, and physiological features, PW is not only a triggering source of AF but also plays a role in the maintenance of AF.…”

Section: Non‐pv Triggersmentioning

confidence: 99%

Cryoballoon ablation of non‐PV triggers in persistent atrial fibrillation

Çöteli,

Dural,

Yorgun

et al. 2023

Pacing Clinical Electrophis

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Cryoballoon‐based catheter ablation has emerged as an efficacious and safe therapeutic intervention for patients with paroxysmal atrial fibrillation (PAF). PAF is primarily associated with the triggers in the pulmonary vein (PV). However, persistent atrial fibrillation (PeAF) is a complex condition that involves changes in the atrial substrate and the presence of non‐PV triggers. Therefore, a comprehensive treatment approach is necessary for patients with PeAF. Utilizing a 3D electroanatomical map, the radiofrequency‐based ablation technique adeptly identifies and targets the atrial substrate and non‐PV triggers. On the other hand, the cryoballoon‐based AF ablation was initially designed for PV isolation. However, its single‐shot feature makes it a great choice for electrophysiologists looking to address non‐PV triggers. It is possible to target the left atrial appendage (LAA), superior vena cava (SVC), left atrial roof, and posterior wall using the apparatus's unique configuration and ablation abilities. This review focuses on the increasing literature regarding cryoballoon‐based methods for non‐PV trigger ablation. Specifically, it delves into the technical procedures used to isolate the LAA, SVC, and ablate the left atrial roof and posterior wall.

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Lymphomonomuclear infiltration and elevated fibrosis extent in the right and left ventricular myocardium is linked to histology of Bachman bundle and associated with history of atrial fibrillation

Cited by 3 publications

References 0 publications

Emerging Antiarrhythmic Drugs for Atrial Fibrillation

Emerging Antiarrhythmic Drugs for Atrial Fibrillation

Catheter Ablation Approaches for the Treatment of Arrhythmia Recurrence in Patients with a Durable Pulmonary Vein Isolation

Cryoballoon ablation of non‐PV triggers in persistent atrial fibrillation

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