New concepts in atrial fibrillation pathophysiology

Abstract

The current classification of atrial fibrillation (AF) is mainly focused on the clinical presentation according to the duration of AF episodes and the mode of termination, which incompletely reflect the severity and progressive nature of the underlying atrial disease. In this review article, “atrial cardiomyopathy” is discussed as a new concept in AF pathophysiology. Electrogram-, imaging-, and biomarker-derived measures and parameters to assess atrial cardiomyopathy, which will likely impact how AF is clinically classified and managed in the future, are presented.

Safety and effectiveness of additional left atrial posterior wall ablation using pulsed field ablation for persistent and long‐standing persistent atrial fibrillation patients

“…This means that when the disease is advanced, such as in ls‐PerAF or high‐UTAH stage disease, even additional ablation, including PWA, is not successful at maintaining sinus rhythm, probably due to the multifactorial etiology of PerAF 25,26 …”

“…12,[22][23][24] This means that when the disease is advanced, such as in ls-PerAF or high-UTAH stage disease, even additional ablation, including PWA, is not successful at maintaining sinus rhythm, probably due to the multifactorial etiology of PerAF. 25,26 Notably, many patients with a high percentage of PW LVAs also had LVAs across the other parts of the LA.…”

Charakterisierung der Vorhofflimmerlast mittels Wearables

“…Die klinisch relevante Charakterisierung von VHF, nach der aktuell Therapieentscheidungen getroffen werden, bezieht sich kategorisch auf die Differenzierung zwischen paroxysmalem, persistierendem und permanentem VHF. Eine genauere Charakterisierung des VHF durch den dynamischen, progressiven Charakter der Vorhoferkrankung und das neue pathophysiologische Konzept der atrialen Kardiomyopathie, rücken in der letzten Zeit vermehrt in den klinischen und wissenschaftlichen Fokus [ 3 – 5 ]. Neben verschiedenen elektrokardiographischen, bildgebenden und biomarkerbasierten Verfahren kann auch die Bestimmung der Vorhofflimmerlast eine weitere, im Vergleich zur kategorischen Einteilung genauere, Differenzierungsmöglichkeit des VHF bieten.…”