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Review
. 2022 Jul 4:9:879984.
doi: 10.3389/fcvm.2022.879984. eCollection 2022.

The Atrium in Atrial Fibrillation - A Clinical Review on How to Manage Atrial Fibrotic Substrates

Pedro Silva Cunha  1   2   3 , Sérgio Laranjo  1   2   3 , Jordi Heijman  4 , Mário Martins Oliveira  1   2   3
Affiliations
Review

The Atrium in Atrial Fibrillation - A Clinical Review on How to Manage Atrial Fibrotic Substrates

Pedro Silva Cunha et al. Front Cardiovasc Med. .

Abstract

Atrial fibrillation (AF) is the most common sustained arrhythmia in the population and is associated with a significant clinical and economic burden. Rigorous assessment of the presence and degree of an atrial arrhythmic substrate is essential for determining treatment options, predicting long-term success after catheter ablation, and as a substrate critical in the pathophysiology of atrial thrombogenesis. Catheter ablation of AF has developed into an essential rhythm-control strategy. Nowadays is one of the most common cardiac ablation procedures performed worldwide, with its success inversely related to the extent of atrial structural disease. Although atrial substrate evaluation remains complex, several diagnostic resources allow for a more comprehensive assessment and quantification of the extent of left atrial structural remodeling and the presence of atrial fibrosis. In this review, we summarize the current knowledge on the pathophysiology, etiology, and electrophysiological aspects of atrial substrates promoting the development of AF. We also describe the risk factors for its development and how to diagnose its presence using imaging, electrocardiograms, and electroanatomic voltage mapping. Finally, we discuss recent data regarding fibrosis biomarkers that could help diagnose atrial fibrotic substrates.

Keywords: atrial fibrillation; atrial substrate; catheter ablation; fibrotic atrial myopathy; pathophysiology.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Pathophysiological dynamics in atrial fibrillation. Adapted from Kottkamp and Schreiber (24). JACC Clin Electrophysiol. AF, atrial fibrillation; PV, pulmonary veins.
FIGURE 2
FIGURE 2
Fibroblast and Fibrin Activity in tissue healing. Visual representation of the pathophysiological process of reparative fibrosis after an injury to the cell.
FIGURE 3
FIGURE 3
Etiology of atrial fibrosis. Different pathological insults, risk factors, and certain genetic diseases induce atrial fibrosis. Atrial fibrosis is characterized by myofibroblast growth and extracellular matrix (ECM) remodeling.
See this image and copyright information in PMC

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