Document Detail


The clinical profile and pathophysiology of atrial fibrillation: relationships among clinical features, epidemiology, and mechanisms.
MedLine Citation:
PMID:  24763464     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
Atrial fibrillation (AF) is the most common arrhythmia (estimated lifetime risk, 22%-26%). The aim of this article is to review the clinical epidemiological features of AF and to relate them to underlying mechanisms. Long-established risk factors for AF include aging, male sex, hypertension, valve disease, left ventricular dysfunction, obesity, and alcohol consumption. Emerging risk factors include prehypertension, increased pulse pressure, obstructive sleep apnea, high-level physical training, diastolic dysfunction, predisposing gene variants, hypertrophic cardiomyopathy, and congenital heart disease. Potential risk factors are coronary artery disease, kidney disease, systemic inflammation, pericardial fat, and tobacco use. AF has substantial population health consequences, including impaired quality of life, increased hospitalization rates, stroke occurrence, and increased medical costs. The pathophysiology of AF centers around 4 general types of disturbances that promote ectopic firing and reentrant mechanisms, and include the following: (1) ion channel dysfunction, (2) Ca(2+)-handling abnormalities, (3) structural remodeling, and (4) autonomic neural dysregulation. Aging, hypertension, valve disease, heart failure, myocardial infarction, obesity, smoking, diabetes mellitus, thyroid dysfunction, and endurance exercise training all cause structural remodeling. Heart failure and prior atrial infarction also cause Ca(2+)-handling abnormalities that lead to focal ectopic firing via delayed afterdepolarizations/triggered activity. Neural dysregulation is central to atrial arrhythmogenesis associated with endurance exercise training and occlusive coronary artery disease. Monogenic causes of AF typically promote the arrhythmia via ion channel dysfunction, but the mechanisms of the more common polygenic risk factors are still poorly understood and under intense investigation. Better recognition of the clinical epidemiology of AF, as well as an improved appreciation of the underlying mechanisms, is needed to develop improved methods for AF prevention and management.
Authors:
Jason Andrade; Paul Khairy; Dobromir Dobrev; Stanley Nattel
Related Documents :
17884364 - Prognostic evaluation by clinical exercise test scores in patients treated with primary...
8857474 - Prediction of late cardiac events by dipyridamole thallium scintigraphy in patients wit...
24296394 - Mid-ventricular tako-tsubo cardiomyopathy with structurally normal coronary arteries co...
10805484 - Vascular imaging: changing the face of cardiovascular research.
7489474 - Haemodynamic changes in children with portal hypertension during the postoperative period.
17348804 - Intravenous delivery of autologous mesenchymal stem cells limits infarct size and impro...
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Circulation research     Volume:  114     ISSN:  1524-4571     ISO Abbreviation:  Circ. Res.     Publication Date:  2014 Apr 
Date Detail:
Created Date:  2014-04-25     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0047103     Medline TA:  Circ Res     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1453-68     Citation Subset:  IM    
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Emergence of blind areas in information spreading.
Next Document:  Emerging directions in the genetics of atrial fibrillation.