Department of Physiology, Amsterdam University Medical Centers, VU Universiteit, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands.
Department of Physiology and Cell Biology, College of Medicine/Wexner Medical Center, The Ohio State University, Columbus, OH, USA.
Nat Rev Dis Primers. 2022 Apr 7;8(1):21. doi: 10.1038/s41572-022-00347-9.
Atrial fibrillation (AF) is the most common cardiac arrhythmia despite substantial efforts to understand the pathophysiology of the condition and develop improved treatments. Identifying the underlying causative mechanisms of AF in individual patients is difficult and the efficacy of current therapies is suboptimal. Consequently, the incidence of AF is steadily rising and there is a pressing need for novel therapies. Research has revealed that defects in specific molecular pathways underlie AF pathogenesis, resulting in electrical conduction disorders that drive AF. The severity of this so-called electropathology correlates with the stage of AF disease progression and determines the response to AF treatment. Therefore, unravelling the molecular mechanisms underlying electropathology is expected to fuel the development of innovative personalized diagnostic tools and mechanism-based therapies. Moreover, the co-creation of AF studies with patients to implement novel diagnostic tools and therapies is a prerequisite for successful personalized AF management. Currently, various treatment modalities targeting AF-related electropathology, including lifestyle changes, pharmaceutical and nutraceutical therapy, substrate-based ablative therapy, and neuromodulation, are available to maintain sinus rhythm and might offer a novel holistic strategy to treat AF.
尽管在理解房颤的病理生理学和开发改进的治疗方法方面付出了巨大努力，但房颤仍然是最常见的心律失常。确定个体患者房颤的潜在病因机制很困难，而且目前的治疗效果并不理想。因此，房颤的发病率稳步上升，迫切需要新的治疗方法。研究表明，特定分子途径的缺陷是房颤发病机制的基础，导致电传导障碍，从而引发房颤。这种所谓的电病理严重程度与房颤疾病进展的阶段相关，并决定了房颤治疗的反应。因此，揭示电病理的分子机制有望为创新的个性化诊断工具和基于机制的治疗方法的发展提供动力。此外，与患者共同开展房颤研究以实施新的诊断工具和治疗方法是成功进行个性化房颤管理的前提。目前，有多种针对房颤相关电病理的治疗方法，包括生活方式改变、药物和营养疗法、基于基质的消融治疗和神经调节，可维持窦性节律，并可能为治疗房颤提供一种新的整体策略。
