Atrial Fibrillation Pathophysiology Implications for Management
Atrial Fibrillation Pathophysiology Implications for Management
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DOI：
10.1161/circulationaha.111.019893
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发表时间：
2011-11-15
期刊：
影响因子：
37.8
通讯作者：
Nattel, Stanley
中科院分区：
文献类型：
--
作者：
Iwasaki, Yu-ki;Nishida, Kunihiro;Nattel, Stanley
房颤是最常见的持续性心律失常，是人群发病率和死亡率的重要因素。房颤是一种在老年人中特别常见的心律失常，随着人口老龄化，房颤的患病率越来越高。我们对房颤发生和持续的基本机制的了解正在迅速增加。本文综述了房颤的基本病理生理学，涉及维持心律失常的组织机制，临床表现与基础机制的关系，导致异位冲动形成的离子通道和转运体异常，折返的基本模型和组织决定因素，折返的离子通道决定因素，电和结构重构的性质和作用，自主神经成分，解剖因素，房颤和房室功能后果之间的相互作用，以及心房血栓栓塞症的基本决定因素。然后，我们回顾了心律失常的基本病理生理学对其处理的潜在意义。我们首先讨论改进节律控制药物治疗的结果：靶向基础条件、新的心房选择性药物靶点、局灶性异位来源抑制的新靶点以及旨在防止重构的上游治疗。然后，我们回顾了心率控制治疗、房颤消融和血栓栓塞事件预防的基本机制考虑的含义。最后，我们对与房颤机制相关的翻译研究的未来进行了一些思考。(发行量。2011；124：2264-2274。)
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. (Circulation. 2011;124:2264-2274.)