Atrial Cardiomyopathy: a Role in the Pathogenesis of Atrial Fibrillation and Influence on the Results of Its Treatment

DOI: https://doi.org/10.30702/ujcvs/21.4512/SA053-8589
Keywords: arrhythmia, atrial fibrillation, catheter destruction, arrhythmogenesis, fibrous substrate

Abstract

The work is dedicated to the issue of atrial cardiomyopathies (ACs). They have a significant effect on the heart function, provoke rhythm disturbances and increase the risk of thromboembolic complications.

The aim. To analyze the latest publications on the topic.

The material for the analysis were the papers published by the leading arrhythmological clinics.

Discussion. This paper describes the origin of the term “atrial cardiomyopathy”, highlights the conditional classification of changes in the atrial myocardium according to the EHRAS classification. The causes of this nosological form may be some types of gene mutations, as well as hypertension, congestive circulatory failure, diabetes mellitus, myocarditis, etc. ACs play an important role in the occurrence of atrial fibrillation (AF) and also affect its natural course and treatment outcomes. Electroanatomical mapping and magnetic resonance data show significant fibrotic changes in the atria in individuals with this form of arrhythmia. The DECAAF study (Delayed enhancement MRI and atrial fibrillation catheter ablation) showed that fibrotic changes in the atrial myocardium are directly related to the frequency of recurrent arrhythmias after catheter ablation. The DECAAFII study confirmed the effectiveness of the influence on the fibrous substrate in the catheter treatment of AF at stages 1 and 2 of fibrosis. The results of catheter treatment depend on the severity of fibrosis, which shows the importance of taking this factor into account when determining the indications for ablation.

Conclusions. Thus, AC is an important component of the pathogenesis of AF. Improvement of techniques for influencing the fibrous substrate will improve the results of catheter treatment of AF.

References

  1. Nagle RE, Smith B, Williams DO. Familial atrial cardiomyopathy with heart block. Br Heart J. 1972;34(2):205. PMID: 5007810.
  2. Zipes DP. Atrial fibrillation. A tachycardia-induced atrial cardiomyopathy. Circulation. 1997;95(3):562-4. https://doi.org/10.1161/01.cir.95.3.562
  3. Kottkamp H. Atrial fibrillation substrate: the «unknownspecies» – from lone atrial fibrillation to fibrotic atrial cardiomyopathy.HeartRhythm.2012;9(4):481-2.https://doi.org/10.1016/j.hrthm.2012.01.008
  4. GoetteA,KalmanJM,AguinagaL,AkarJ,CabreraJA,ChenSA, et al. EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: Definition, characterization, and clinical implication. Heart Rhythm. 2017;14(1):e3-e40. https://doi.org/10.1016/j.hrthm.2016.05.028
  5. Fatkin D, Santiago CF, Huttner IG, Lubitz SA, Ellinor PT. Genetics of atrial fibrillation: state of the art in 2017. Heart Lung Circ. 2017;26(9):894-901. https://doi.org/10.1016/j.hlc.2017.04.008
  6. Fatkin D, Huttner IG, Johnson R. Genetics of atrial cardiomyopathy. Curr Opin Cardiol. 2019;34(3):275-81. https://doi.org/10.1097/HCO.0000000000000610
  7. Roselli C, Rienstra M, Ellinor PT. Genetics of atrial fibrillation in 2020: GWAS, genome sequencing, polygenic risk, and beyond. Circ Res. 2020;127(1):21-33. https://doi.org/10.1161/CIRCRESAHA.120.316575
  8. Guichard JB, Nattel S. Atrial cardiomyopathy: a useful notion in cardiac disease management or a passing fad? J Am Coll Cardiol. 2017;70(6):756-65. https://doi.org/10.1016/j.jacc.2017.06.033
  9. Platonov PG, Mitrofanova LB, Orshanskaya V, Ho SY. Structural abnormalities in atrial walls are associated with presence and persistency of atrial fibrillation but not with age. J Am Coll Cardiol. 2011;58(21):2225-32. https://doi.org/10.1016/j.jacc.2011.05.061
  10. Corradi D, Callegari S, Manotti L, Ferrara D, Goldoni M, Alinovi R, Pinelli S, Mozzoni P, Andreoli R, Asimaki A, Pozzoli A, Becchi G, Mutti A, Benussi S, Saffitz JE, Alfieri O. Persistent lone atrial fibrillation: clinicopathologic study of 19 cases. Heart Rhythm. 2014;11(7):1250-8. https://doi.org/10.1016/j.hrthm.2014.02.008
  11. Kottkamp H, Schreiber D. The substrate in «early persistent» atrial fibrillation: arrhythmia induced, risk factor induced, or from a specific fibrotic atrial cardiomyopathy?JACCClinElectrophysiol.2016;2(2):140-2. https://doi.org/10.1016/j.jacep.2016.02.010. Epub 2016 Apr 18.
  12. Andreasen L, Bertelsen L, Ghouse J, Lundegaard PR, Ahlberg G, Refsgaard L, Rasmussen TB, Eiskjær H, Haunsø S, Vejlstrup N, Svendsen JH, Olesen MS. Early-onset atrial fibrillation patients show reduced left ventricular ejection fraction and increased atrial fibrosis. Sci Rep. 2020;10(1):10039. https://doi.org/10.1038/s41598-020-66671-w
  13. Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, Boriani G, Castella M, Dan GA, Dilaveris PE, Fauchier L, Filippatos G, Kalman JM, La Meir M, Lane DA, Lebeau JP, Lettino M, Lip GYH, Pinto FJ, Thomas GN, Valgimigli M, Van Gelder IC, Van Putte BP, Watkins CL; ESC Scientific Document Group. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery. Eur Heart J. 2021;42(5):373-498. https://doi.org/10.1093/eurheartj/ehaa612
  14. Marrouche NF, Wilber D, Hindricks G, Jais P, Akoum N, MarchlinskiF,KholmovskiE,BurgonN,HuN,MontL,Deneke T, Duytschaever M, Neumann T, Mansour M, Mahnkopf C, Herweg B, Daoud E, Wissner E, Bansmann P, Brachmann J. Association of atrial tissue fibrosis identified by delayed enhancement MRI and atrial fibrillation catheter ablation: the DECAAF study. JAMA. 2014;311(5):498-506. https://doi.org/10.1001/jama.2014.3
  15. Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, et al. 2017 HRS/EHRA/ECAS/APHRS/ SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm. 2017;14(10):e275-e444. https://doi.org/10.1016/j.hrthm.2017.05.012
  16. Marrouche NF, Greene T, Dean JM, Kholmovski EG, Boer LM, Mansour M, Calkins H, Marchlinski F, Wilber D, Hindricks G, Mahnkopf C, Jais P, Sanders P, Brachmann J, Bax J, Dagher L, Wazni O, Akoum N; DECAAF II Investigators. Efficacy of LGE-MRI–guided fibrosis ablation versus conventional catheter ablation of atrial fibrillation: The DECAAF II trial: Study design. J Cardiovasc Electrophysiol. 2021;32(4):916-24. https://doi.org/10.1111/jce.14957
  17. ESC [Internet]. Sophia Antipolis: ESC; c2021 Aug 28 [cited 2021 Sep 28]. Fibrosis ablation shows promise in atrial fibrillation with low grade fibrotic myopathy [Press release]. Available from: https://www.escardio.org/The-ESC/Press-Office/Press-releases/Fibrosis-ablation-shows-promise-in-atrial-fibrillation-with-low-grade-fibrotic-myopathy
Published
2021-12-22
How to Cite
Stychynskyi, O. S., Almiz, P. O., & Topchii, A. V. (2021). Atrial Cardiomyopathy: a Role in the Pathogenesis of Atrial Fibrillation and Influence on the Results of Its Treatment. Ukrainian Journal of Cardiovascular Surgery, (4 (45), 85-89. https://doi.org/10.30702/ujcvs/21.4512/SA053-8589
Issue
Ukrainian Journal of Cardiovascular Surgery No 4 (45) 2021
Section
HEART RHYTHM DISORDER