Kariki Ourania, Vlachos Konstantinos, Dragasis Stylianos, Tsetika Eleftheria-Garyfalia, Perlepe Kalliopi, Saplaouras Athanasios, Nyktari Eva, Efremidis Michael, Letsas Konstantinos P
Arrhythmia Unit, Onassis Cardiac Surgery Center, 17674 Athens, Greece.
Arrhythmia Unit, Onassis Cardiac Surgery Center, 17674 Athens, Greece.
J Electrocardiol. 2023 Jan-Feb;76:1-10. doi: 10.1016/j.jelectrocard.2022.10.012. Epub 2022 Nov 4.
Atrial cardiomyopathy (AC) is an evolving pathophysiological entity that has expanded our understanding regarding the atrium and its role in arrhythmogenesis and cardiac thromboembolism. The pathological myocardium in AC promotes arrhythmogenesis through mechanical dysfunction (hypocontractility, fibrosis), adverse alterations of the endothelium and secretion of prothrombotic factors (IL-6, IL-8, TNF-a). 'Red flags', indicative of AC, can be recognized either non-invasively by electrocardiography, echocardiography and cardiac magnetic resonance imaging or invasively by high-density electroanatomical mapping as low bipolar voltage areas of the affected myocardium. Signs of AC have been strongly associated with an increased risk of ischemic stroke, even embolic strokes of undetermined source, regardless of the coexistence of atrial fibrillation (AF). The underlying existence of AC has been negatively correlated with the success rate of catheter ablation of AF. The clinical value of AC is the provision of a novel pathway regarding the potential mechanisms of cerebrovascular events of cardiac thromboembolic origin. In addition, AC may serve as a risk stratification tool to predict the long-term responders of AF catheter ablation.
心房心肌病（AC）是一种不断演变的病理生理实体，它拓展了我们对心房及其在心律失常发生和心脏血栓栓塞中作用的认识。AC中的病理性心肌通过机械功能障碍（收缩力减弱、纤维化）、内皮的不良改变以及促血栓形成因子（白细胞介素-6、白细胞介素-8、肿瘤坏死因子-α）的分泌促进心律失常的发生。提示AC的“红旗”指标，可通过心电图、超声心动图和心脏磁共振成像等非侵入性方法识别，也可通过高密度电解剖标测作为受影响心肌的低双极电压区域进行侵入性识别。AC的体征与缺血性卒中风险增加密切相关，即使是来源不明的栓塞性卒中，无论是否存在心房颤动（AF）。AC的潜在存在与AF导管消融的成功率呈负相关。AC的临床价值在于为心脏血栓栓塞性起源的脑血管事件的潜在机制提供了一条新途径。此外，AC可作为一种风险分层工具，以预测AF导管消融的长期反应者。
