Heart Center, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, PR China.
Section for Cardiac Electrophysiology, Department of Medicine/Cardiology, Johns Hopkins University School of Medicine, Baltimore, USA.
Hellenic J Cardiol. 2019 Jul-Aug;60(4):216-223. doi: 10.1016/j.hjc.2019.04.005. Epub 2019 Apr 18.
Characterized by lack of evidence of structural heart disease or any secondary causes of atrial fibrillation (AF), "lone AF" is used to represent a unique subtype of AF among young individuals aged less than 60 years. Although the longstanding definition has been proposed for years, the diagnostic criteria for "lone AF" remain ambiguous. As more contributing factors causing AF are recognized gradually, the validity of the term "lone AF" is in question. Despite advances in the past few decades, the mechanism of AF remains poorly understood, particularly in the absence of other structural changes. It is generally accepted that three essential electrophysiological elements (trigger, substrate, and modulators) contribute to the initiation and maintenance of lone AF. In addition, the role of microRNAs and genomic variations in the pathogenesis of lone AF has been also gaining attention. Some changes in relevant biomarker levels have also been proven to correlate with lone AF. Accumulating insights into the pathogenesis of lone AF strongly suggest coexistent disorders in patients with lone AF. Consequently, the growing evidence of these numerous and diverse pathogenic mechanisms and factors related to lone AF inevitably raises the question of whether the term "lone AF" is a meaningful category. The classification of lone AF as a separate identity has not lead to any unique clinical management. In this review, we update knowledge of definition, mechanisms, genetics, biomarkers, and clinical management of "lone AF." With this comprehensive review, we suggest that the term "lone AF" should be abandoned for its futility.
以缺乏结构性心脏病或心房颤动（AF）的任何继发性原因为特征，“孤立性 AF”用于代表 60 岁以下年轻人中独特的 AF 亚型。尽管多年来一直提出长期定义，但“孤立性 AF”的诊断标准仍不明确。随着越来越多导致 AF 的致病因素被逐渐认识，“孤立性 AF”一词的有效性受到质疑。尽管在过去几十年中取得了进展，但 AF 的发病机制仍了解甚少，特别是在没有其他结构变化的情况下。人们普遍认为，三个基本的电生理要素（触发、底物和调节剂）有助于孤立性 AF 的起始和维持。此外，microRNAs 和基因组变异在孤立性 AF 发病机制中的作用也受到关注。一些相关生物标志物水平的变化也被证明与孤立性 AF 相关。对孤立性 AF 发病机制的深入了解强烈表明孤立性 AF 患者存在共存疾病。因此，与孤立性 AF 相关的这些众多和多样化的发病机制和因素的证据不断增加，不可避免地引发了一个问题，即“孤立性 AF”一词是否是一个有意义的类别。将孤立性 AF 归类为单独的疾病并没有导致任何独特的临床管理。在这篇综述中，我们更新了对“孤立性 AF”的定义、机制、遗传学、生物标志物和临床管理的认识。通过这篇全面的综述，我们建议放弃“孤立性 AF”一词，因为它没有意义。
