Vnitr Lek 2010, 56(8):871-879

Atrial fibrillation in the era of catheter ablation

R. Lábrová
Interní kardiologická klinika Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta prof. MUDr. Jindřich Špinar, CSc., FESC

Atrial fibrillation is the most frequent heart rhythm abnormality and is associated with increased morbidity and mortality. Trigerring ectopias and arrhythmogenic substrate that enable arrhythmia to sustain are both influenced by many modulating factors. Which risk factor is the most signifficant one remains unknown. Understanding pathophysiology of atrial fibrillation including molecular and genetic aspects is necessary to assign the most effective preventive measures as well as treatment of atrial fibrillation. Pharmacological treatment is the method of choice but "upstream therapy" that counteracts atrial remodelling has been more and more discussed. Presently the most effective treatment of atrial fibrillation is catheter ablation. Successful ablation prevents from the progression of electrical, structural and mechanical myocardial remodelling, improves left ventricle function and the risk of trombembolism drops to the level of healthy population. The restitution of sinus rhythm triggers a reversal remodelling. We present results of catheter ablations performed at Internal Cardiology Department of the MU Medical Faculty and Faculty Hospital Brno.

Keywords: atrial fibrillation; pathophysiology; remodelling; upstream therapy; catheter ablation

Received: June 4, 2010; Published: August 1, 2010  Show citation

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Lábrová R. Atrial fibrillation in the era of catheter ablation. Vnitr Lek. 2010;56(8):871-879.
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References

  1. Go AS, Hylek EM, Phillips KA et al. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA 2001; 285: 2370-2375. Go to original source... Go to PubMed...
  2. Feinberg WM, Blackshear JL, Laupacis A et al. Prevalence, age distribution, and gender of patients with atrial fibrillation. Analysis and implications. Arch Intern Med 1995; 155: 469-473. Go to original source...
  3. Tsang TS, Petty GW, Barnes ME et al. The prevalence of atrial fibrillation in incident stroke cases and matched population controls in Rochester, Minnesota: changes over three decades. J Am Coll Cardiol 2003; 42: 93-100. Go to original source... Go to PubMed...
  4. Miyasaka Y, Barnes ME, Gersh BN et al. Secular trend incidence of atrial fibrillation in Olmsted County, Minnesota, 1980 to 2000, and implications on the projection for future prevalence. Circulation 2006; 114: 119-125. Go to original source... Go to PubMed...
  5. Furberg CD, Psaty BM, Manolio TA et al. Prevalence of atrial fibrillation in elderly subject (the Cardiovascular Health Study). Am J Cardiol 1994; 74: 236-241. Go to original source... Go to PubMed...
  6. Maisel WH, Stevenson LW. Atrial fibrillation in heart failure: epidemiology, pathophysiology, and rationale for therapy. Am J Cardiol 2003; 91: 2D-8D. Go to original source... Go to PubMed...
  7. Cha YM, Redfield MM, Shen WK et al. Atrial fibrillation and ventricular dysfunction: a vicious electromechanical cycle. Circulation 2004; 109: 2839-2843. Go to original source... Go to PubMed...
  8. Lábrová R, Špinar J. Srdeční selhání a fibrilace síní. Cor Vasa 2008; 50: 385-392. Go to original source...
  9. Fuster V, Rydén LE, Cannom DS et al. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation-executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines. Eur Heart J 2006; 27: 1979-2030. Go to original source... Go to PubMed...
  10. Gentlesk PJ, Sauer WH, Gerstenfeld EP et al. Reversal of left ventricular dysfunction following ablation of atrial fibrillation. J Cardiovasc Electophysiol 2007; 18: 9-14. Go to original source... Go to PubMed...
  11. McGovern PG, Jacobs DR Jr, Shahar E et al. Trends in acute coronary heart disease mortality, morbidity, and medical care from 1985 through 1997: the Minnesota Heart Survey. Circulation 2001; 104: 19-24. Go to original source... Go to PubMed...
  12. Go AS, Hylek EM, Phillips KA et al. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA 2001; 285: 2370-2375. Go to original source... Go to PubMed...
  13. Brugada R. Molecular biology of atrial fibrillation. Minerva Cardioangiol 2004; 52: 65-72. Go to PubMed...
  14. Feng J, Yue L, Wang Z et al. Ionic mechanism of regional action potential heterogeneity in the canine right atrium. Circ Res 1998; 83: 541-551. Go to original source... Go to PubMed...
  15. Bosch RF, Scherer CR, Rub NL et al. Molecular mechanisms of early electrical remodeling: transcriptional downregulation of ion channel subunits deduces I (Ca, L) an I (to) in rapid atrial pacing in rabbits. J Am Coll Cardiol 2003; 41: 858-869. Go to original source... Go to PubMed...
  16. Madrid AH, Escobar C, Rebollo JM et al. Angiotensin receptor blocker as adjunctive therapy for rhythm control in atrial fibrillation: results of the irbesartan-amiodarone trial. Card Electrophysiol Rev 2003; 7: 243-246. Go to original source... Go to PubMed...
  17. Douglas P. The left atrium: a biomarker of chronic diastolic dysfunction and cardiovascular disease risk. J Am Coll Cardiol 2003; 42: 1206-1207. Go to original source... Go to PubMed...
  18. Morillo CA, Klein GJ, Jones DL et al. Chronic rapid atrial pacing. Structural, functional, and electrophysiological characteristics of a new model of sustained atrial fibrillation. Circulation 1995; 91: 1588-1595. Go to original source... Go to PubMed...
  19. Goette A, Arndt M, Röcken C et al. Regulation of angiotension II receptors subtypes during atrial fibrillation in humans. Circulation 2000; 101: 2678-2681. Go to original source... Go to PubMed...
  20. Goette A, Staack T, Röcken C et al. Increased expression of extracellular signal-regulated kinase and angiotensin-converting enzyme in human atria during atrial fibrillation. J Am Coll Cardiol 2000; 35: 1669-1677. Go to original source... Go to PubMed...
  21. Haïssaguerre M, Jaïs P, Shah DC et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med 1998; 339: 659-666. Go to original source... Go to PubMed...
  22. Chen YH, Xu SJ, Bendahhou S et al. KCNQ1 gain-of-function mutation in familial atrial fibrillation. Science 2003; 299: 251-254. Go to original source... Go to PubMed...
  23. Tsai CT, Lai LP, Lin JL et al. Renin-angiotensin system gene polymorphisms and atrial fibrillation. Circulation 2004; 109: 1640-1646. Go to original source... Go to PubMed...
  24. Korantzopoulos P, Kolettis TM, Galaris D et al. The role of oxidative stress in the pathogenesis and perpetuation of atrial fibrillation. Int J Cardiol 2007; 115: 135-143. Go to original source... Go to PubMed...
  25. Tsang TS, Gersh BJ, Appleton CP. Left ventricular diastolic dysfunction as a predictor of the first diagnosed nonvalvular atrial fibrillation in 840 elderly men and women. J Am Coll Cardiol 2002; 40: 1636-1644. Go to original source... Go to PubMed...
  26. Lábrová R. Epidemiologie fibrilace síní. Kardiofórum 2007; 5: 6-10.
  27. Gami AS, Pressman G, Caples SM et al. Association of atrial fibrillation and obstructive sleep apnea. Circulation 2004; 110: 364-367. Go to original source... Go to PubMed...
  28. Shamsuzzaman AS, Winnicki M, Lanfranchi P et al. Elevated C-reactive protein in patients with obstructive sleep apnea. Circulation 2002; 105: 2462-2464. Go to original source... Go to PubMed...
  29. Das UN. Is angiotensin-II an endogenous pro-inflammatory molecule? Med Sci Monit 2005; 11: RA155-RA162.
  30. Brown NJ, Vaughan DE. Prothrombotic effects of angiotensin. Adv Intern med 2000; 45: 419-429.
  31. Lábrová R, Špinar J. Inhibitory ACE, sartany a fibrilace síní. Intern Med 2009; 11: 327-331.
  32. Špinar J, Lábrová R. ACTIVE I a upstream terapie. Interv Akut Kardiol 2009; 8: 325-327.
  33. AFFIRM First Antiarrhythmic Drug Substudy Investigators. Maintenance of sinus rhythm in patients with atrial fibrillation: an AFFIRM substudy of the first antiarrhythmic drug. J Am Coll Cardiol 2003; 42: 20-29.
  34. Chun SH, Sager PT, Stevenson WG et al. Long-term efficacy of amiodarone for the maintenance of normal sinus rhythm in patients with refractory atrial fibrillation or flutter. Am J Cardiol 1995; 76: 47-50. Go to original source... Go to PubMed...
  35. Hohnloser SH, Crijns HJ, van Eickels M et al. Effects of dronedarone on cardiovascular events in atrial fibrillation. N Engl J Med 2009; 360: 668-678. Go to original source... Go to PubMed...
  36. Calò L, Bianconi L, Colivicchi F et al. N-3 fatty acids for the prevention of atrial fibrillation after coronary artery bypass surgery: a randomized, controlled trial. J Am Coll Cardiol 2005; 45: 1723-1728. Go to original source... Go to PubMed...
  37. Dernellis J, Panaretou M. Relationship between C-reactive protein concentrations during glucocorticoid therapy and recurrent atrial fibrillation. Eur Heart J 2004; 25: 1100-1107. Go to original source... Go to PubMed...
  38. Young-Xu Y, Jabbour S, Goldberg R et al. Usefulness of statin drugs in protecting against atrial fibrillation in patients with coronary artery disease. Am J Cardiol 2003; 92: 1379-1383. Go to original source... Go to PubMed...
  39. Hohnloser SH, Kuck KH, Lilienthal J et al. Rhythm or rate control in atrial fibrillation-pharmacological intervention in atrial fibrillation (PIAF): a randomized trial. Lancet 2000; 356: 1789-1794. Go to original source... Go to PubMed...
  40. van Gelder IC, Hagens VE, Bosker HA et al. Rate Control versus Electrical Cardioversion for Persistent Atrial Fifrillation (RACE) Study Group. A comparison of rate control and rhythm control in patients with recurrent persistent atrial fibrillation. N Engl J Med 2002; 347: 1834-1840. Go to original source... Go to PubMed...
  41. Carlsson J, Miketic S, Windeler J et al. Randomized trial of rate-control versus rhythm-control in persistent atrial fibrillation: STAF (Strategies of Treatment of Atrial Fibrillation) study. J Am Coll Cardiol 2003; 41: 1690-1696. Go to original source... Go to PubMed...
  42. Wyse DG, Waldo AL, DiMarco JP et al. Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) Investigators. A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med 2002; 347: 1825-1833. Go to original source... Go to PubMed...
  43. Corley SD, Epstein AE, DiMarco JP et al. AFFIRM Investigators. Relationships between sinus rhythm, treatment, and survival in the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study. Circulation 2004; 109: 1509-1513. Go to original source... Go to PubMed...
  44. Pappone C, Rosanio S, Augello G et al. Mortality, morbidity, and quality of life after circumferential pulmonary vein ablation for atrial fibrillation: outcomes from a controlled nonrandomized long-term study. J Am Coll Cardiol 2003; 42: 185-197. Go to original source... Go to PubMed...
  45. Wazni OM, Marrouche NF, Martin DO et al. Radiofrequency ablation vs antiarrhythmic drugs as first-line treatment of symptomatic atrial fibrillation: a randomized trial. JAMA 2005; 293: 2634-2640. Go to original source... Go to PubMed...
  46. Stabile G, Bertaglia E, Senatore G et al. Catheter ablation treatment in patients with drug-refractory atrial fibrillation: a prospective, multi-centre, randomized, controlled study (Catheter Ablation For The Cure of Atrial Fibrillation Study). Eur Heart J 2006; 27: 216-221. Go to original source... Go to PubMed...
  47. Pappone C, Augello G, Sala S et al. A randomized trial of circumferential pulmonary vein ablation versus antiarrhythmic drug therapy in paroxysmal atrial fibrillation: the APAF Study. J Am Coll Cardiol 2006; 48: 2340-2347. Go to original source... Go to PubMed...
  48. Jais P, Cauchemez B, Macle L. Atrial fibrillation ablation vs antiarrhythmic drugs: a multicenter randomized trial. Heart Rhythm 2006; 3. Abstract 1126. Go to original source...
  49. Oral H, Pappone C, Chugh A et al. Circumferential pulmonary-vein ablation for chronic atrial fibrillation. N Engl J Med 2006; 354: 934-941. Go to original source... Go to PubMed...
  50. Lábrová R, Špinar J. Katetrizační ablace fibrilace síní. Kardiol. Rev 2008, 10: 103-110.
  51. Lábrová R, Fiala M, Toman O et al. Radiofrekvenční katetrová ablace paroxyzmální fibrilace síní konvenční metodou, bezprostřední a dlouhodobé výsledky. Vnitř Lék 2008; 54: 953-960. Go to PubMed...




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