Burashnikov Alexander, Antzelevitch Charles
Lankenau Institute for Medical Research, Wynnewood, PA, USA.
Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA.
Pacing Clin Electrophysiol. 2018 Oct;41(10):1289-1297. doi: 10.1111/pace.13474. Epub 2018 Sep 9.
Atrial fibrillation (AF) affects 10-50% of patients with chronic heart failure (HF) and is associated with poor long-term prognosis. AF is commonly associated with atrial structural remodeling (ASR), principally characterized by atrial dilatation and fibrosis. However, the occurrence of AF in the full spectrum of ASR encountered in patients with HF is poorly defined. Experimental studies have presented evidence that extensive ASR can be accompanied with a reduced burden of AF, secondary to a prominent depression of atrial excitability. This reduction in AF burden is associated with severe atrial fibrosis rather than with dilatation. Clinical studies of patients with HF point to the possibility that advanced ASR is associated with a less frequent AF occurrence than moderate ASR. Our goal in this review is to introduce the hypothesis that AF is less likely to occur in severe versus moderate atrial ASR in the setting of HF and that it is severe atrial fibrosis-associated depression of atrial excitability that reduces AF burden.
心房颤动（AF）影响10%-50%的慢性心力衰竭（HF）患者，并与不良的长期预后相关。AF通常与心房结构重塑（ASR）有关，主要特征是心房扩张和纤维化。然而，在HF患者中遇到的整个ASR范围内AF的发生情况尚不清楚。实验研究表明，广泛的ASR可伴有AF负担减轻，这是由于心房兴奋性显著降低所致。AF负担的这种减轻与严重心房纤维化有关，而非与扩张有关。HF患者的临床研究表明，与中度ASR相比，晚期ASR与AF发生频率较低的可能性相关。本综述的目的是提出这样一种假设：在HF背景下，严重心房ASR与中度心房ASR相比，AF发生的可能性较小，并且是严重心房纤维化相关的心房兴奋性降低减轻了AF负担。
