Begg, GA orcid.org/0000-0001-5260-4293, Holden, AV, Lip, GYH et al. (2 more authors) (2016) Assessment of atrial fibrosis for the rhythm control of atrial fibrillation. International Journal of Cardiology, 220. pp. 155-161. ISSN 0167-5273
Abstract
Rhythm control of atrial fibrillation (AF) remains challenging, with modest long-term success rates. Atrial fibrosis has been associated with AF, but the clinical utility of assessment of this fibrosis has yet to be fully elucidated. In this paper we review the current state of understanding of the pathophysiology of atrial fibrosis in AF, and its impact upon the instigation and propagation of the arrhythmia. Fibrosis causes an increase in volume of dysfunctional extracellular matrix, and is associated with cellular alterations such as hypertrophy, apoptosis and membrane dysfunction within the atrial myocardium. In turn, these cause pathological alterations to atrial conduction, such as increased anisotropy, conduction block and re-entry, which can lead to AF. We review current methods of assessing atrial fibrosis and their impact upon the prediction of success of interventional rhythm control strategies such as ablation and cardioversion. We focus particularly on circulating biomarkers of fibrosis and scar formation; their role in the fibrotic process, and their value in the prediction of rhythm control success. We also review imaging and invasive electrocardiographic mapping techniques that may identify fibrosis, and again assess their potential predictive value. In this area there exist many unanswered questions, but further work will help to refine techniques to reliably identify and treat those patients who are most likely to benefit from rhythm control treatment strategies.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2016 Elsevier Ireland Ltd. This is an author produced version of a paper published in International Journal of Cardiology. Uploaded in accordance with the publisher's self-archiving policy. |
Keywords: | Atrial fibrillation; Fibrosis; Catheter ablation; Cardioversion |
Dates: |
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Institution: | The University of Leeds |
Academic Units: | The University of Leeds > Faculty of Biological Sciences (Leeds) > School of Biomedical Sciences (Leeds) The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) |
Funding Information: | Funder Grant number British Heart Foundation FS/10/062/28409 |
Depositing User: | Symplectic Publications |
Date Deposited: | 26 Sep 2016 14:13 |
Last Modified: | 30 Jun 2017 19:02 |
Published Version: | http://dx.doi.org/10.1016/j.ijcard.2016.06.144 |
Status: | Published |
Publisher: | Elsevier |
Identification Number: | 10.1016/j.ijcard.2016.06.144 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:105049 |