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Review
. 2023 Jun 12;13(6):1370.
doi: 10.3390/life13061370.

Atrial Fibrillation and Chronic Coronary Ischemia: A Challenging Vicious Circle

Alexandru Florinel Oancea  1   2 , Raul Alexandru Jigoranu  1   2 , Paula Cristina Morariu  1   3 , Radu-Stefan Miftode  1   2 , Bogdan Andrei Trandabat  1   2 , Diana Elena Iov  1   3 , Elena Cojocaru  1   4 , Irina Iuliana Costache  1   2 , Livia Genoveva Baroi  1   5 , Daniel Vasile Timofte  1   5 , Daniela Maria Tanase  1   3 , Mariana Floria  1   3
Affiliations
Review

Atrial Fibrillation and Chronic Coronary Ischemia: A Challenging Vicious Circle

Alexandru Florinel Oancea et al. Life (Basel). .

Abstract

Atrial fibrillation, the most frequent arrhythmia in clinical practice and chronic coronary syndrome, is one of the forms of coronary ischemia to have a strong dual relationship. Atrial fibrillation may accelerate atherosclerosis and may increase oxygen consumption in the myocardium, creating a mismatch between supply and demand, thus promoting the development or worsening of coronary ischemia. Chronic coronary syndrome alters the structure and function of gap junction proteins, affecting the conduction of action potential and leading to ischemic necrosis of cardiomyocytes and their replacement with fibrous tissue, in this way sustaining the focal ectopic activity in atrial myocardium. They have many risk factors in common, such as hypertension, obesity, type 2 diabetes mellitus, and dyslipidemia. It is vital for the prognosis of patients to break this vicious circle by controlling risk factors, drug therapies, of which antithrombotic therapy may sometimes be challenging in terms of prothrombotic and bleeding risk, and interventional therapies (revascularization and catheter ablation).

Keywords: atrial fibrillation; chronic coronary syndrome; coronary artery disease; coronary ischemia; triple antithrombotic therapy.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The trigger and substrate in atrial fibrillation pathogenesis.
Figure 2
Figure 2
The evolution of atherosclerotic plaque.
Figure 3
Figure 3
The 11 steps to assess the SYNTAX score.
Figure 4
Figure 4
The vicious circle between atrial fibrillation and chronic coronary syndrome.
See this image and copyright information in PMC

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