The DOI matches its Crossref record; 86 of the 86 references it cites were found in a registry or an index.
Atrial Fibrillation Pathophysiology: Implications for Management
Abstract
Atrial fibrillation (AF), the most common sustained cardiac arrhythmia, is an important contributor to population morbidity and mortality. An arrhythmia that is particularly common in the elderly, AF is growing in prevalence with the aging of the population. Our understanding of the basic mechanisms that govern AF occurrence and persistence has been increasing rapidly. This article reviews the basic pathophysiology of AF over a broad range of levels, touching on the tissue mechanisms that maintain the arrhythmia, the relationship between clinical presentation and basic mechanisms, ion channel and transporter abnormalities that lead to ectopic impulse formation, basic models and tissue determinants of reentry, ion channel determinants of reentry, the nature and roles of electric and structural remodeling, autonomic neural components, anatomic factors, interactions between atrial and ventricular functional consequences of AF, and the basic determinants of atrial thromboembolism. We then review the potential implications of the basic pathophysiology of the arrhythmia for its management. We first discuss consequences for improved rhythm control pharmacotherapy: targeting underlying conditions, new atrium-selective drug targets, new targets for focal ectopic source suppression, and upstream therapy aiming to prevent remodeling. We then review the implications of basic mechanistic considerations for rate control therapy, AF ablation, and the prevention of thromboembolic events. We conclude with some thoughts about the future of translational research related to AF mechanisms.
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Citations
Cites
Spontaneous Initiation of Atrial Fibrillation by Ectopic Beats Originating in the Pulmonary Veins
Haïssaguerre, M., Jaïs, P., Shah, D. C., Takahashi, A., Hocini, M., Quiniou, G., Garrigue, S., Le Mouroux, A., Le Métayer, P., & Clémenty, J. (1998) · New England Journal of Medicine · doi:10.1056/nejm199809033391003 · Cited by 7,975
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Calkins, H., Brugada, J., Packer, D. L., Cappato, R., Chen, S.-A., Crijns, H. J. G., Damiano, R. J., Davies, D. W., Haines, D. E., Haissaguerre, M., et al. (2007) · Heart Rhythm · doi:10.1016/j.hrthm.2007.04.005 · Cited by 1,701
Rhythm control versus rate control for atrial fibrillation and heart failure
Roy, D., Talajic, M., Nattel, S., Wyse, D. G., Dorian, P., Lee, K. L., Bourassa, M. G., Arnold, J. M. O., Buxton, A. E., Camm, A. J., et al. (2008) · New England Journal of Medicine · doi:10.1056/nejmoa0708789 · Cited by 1,585
New ideas about atrial fibrillation 50 years on
Nattel, S. (2002) · Nature · doi:10.1038/415219a · Cited by 1,481
Self-citationCalkins, H., Brugada, J., Packer, D. L., Cappato, R., Chen, S.-A., Crijns, H. J. G., Damiano, R. J., Davies, D. W., Haines, D. E., Haissaguerre, M., et al. (2007) · Europace · doi:10.1093/europace/eum120 · Cited by 1,290
Pathophysiological mechanisms of atrial fibrillation: a translational appraisal
Schotten, U., Verheule, S., Kirchhof, P., & Goette, A. (2011) · Physiological Reviews · doi:10.1152/physrev.00031.2009 · Cited by 1,273
Atrial Fibrosis: Mechanisms and Clinical Relevance in Atrial Fibrillation
Burstein, B., & Nattel, S. (2008) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2007.09.064 · Cited by 1,242
Self-citationAtrial Remodeling and Atrial Fibrillation: Mechanisms and Implications
Nattel, S., Burstein, B., & Dobrev, D. (2008) · Circulation: Arrhythmia and Electrophysiology · doi:10.1161/circep.107.754564 · Cited by 1,124
Self-citationMechanisms of thrombogenesis in atrial fibrillation: Virchow's triad revisited
Watson, T., Shantsila, E., & Lip, G. Y. (2009) · The Lancet · doi:10.1016/s0140-6736(09)60040-4 · Cited by 1,123
Cited by
Joglar, J. A., Chung, M. K., Armbruster, A. L., Benjamin, E. J., Chyou, J. Y., Cronin, E. M., Deswal, A., Eckhardt, L. L., Goldberger, Z. D., Gopinathannair, R., et al. (2024) · Circulation · doi:10.1161/cir.0000000000001193 · Cited by 2,765
2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation
Joglar, J. A., Chung, M. K., Armbruster, A. L., Benjamin, E. J., Chyou, J. Y., Cronin, E. M., Deswal, A., Eckhardt, L. L., Goldberger, Z. D., Gopinathannair, R., et al. (2024) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2023.08.017 · Cited by 933
Rolf, S., Kircher, S., Arya, A., Eitel, C., Sommer, P., Richter, S., Gaspar, T., Bollmann, A., Altmann, D., Piedra, C., et al. (2014) · Circulation: Arrhythmia and Electrophysiology · doi:10.1161/circep.113.001251 · Cited by 561
Modernized Classification of Cardiac Antiarrhythmic Drugs
Lei, M., Wu, L., Terrar, D. A., & Huang, C. L.-H. (2018) · Circulation · doi:10.1161/circulationaha.118.035455 · Cited by 319
Atrial Fibrillation Promotion by Endurance Exercise
Guasch, E., Benito, B., Qi, X., Cifelli, C., Naud, P., Shi, Y., Mighiu, A., Tardif, J.-C., Tadevosyan, A., Chen, Y., et al. (2013) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2013.01.091 · Cited by 302
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Metadata
- Authors
- Iwasaki, Y.-K., Nishida, K., Kato, T., & Nattel, S.
- Venue
- Circulation
- Published
- 2011-11-15
- Volume
- 124
- Issue
- 20
- Pages
- 2264-2274
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2105454146
- Cited by
- 852
- References
- 86
- FWCI
- 26.04
- Type
- journal article
- Language
- en
- Open access
- closed
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- Iwasaki, Y.-K., Nishida, K., Kato, T., & Nattel, S. (2011). Atrial Fibrillation Pathophysiology: Implications for Management. Circulation. https://doi.org/10.1161/circulationaha.111.019893
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