Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Centro Neurolesi Bonino Pulejo, Messina, Italy.
Centro Nacional de Investigaciones Cardiovasculares (CNIC), Programa Nuevos Mecanismos Arritmogénicos, Madrid, Spain; Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Rev Esp Cardiol (Engl Ed). 2024 Aug;77(8):656-666. doi: 10.1016/j.rec.2024.02.009. Epub 2024 Feb 29.
Atrial fibrillation (AF) causes progressive structural and electrical changes in the atria that can be summarized within the general concept of atrial remodeling. In parallel, other clinical characteristics and comorbidities may also affect atrial tissue properties and make the atria susceptible to AF initiation and its long-term persistence. Overall, pathological atrial changes lead to atrial cardiomyopathy with important implications for rhythm control. Although there is general agreement on the role of the atrial substrate for successful rhythm control in AF, the current classification oversimplifies clinical management. The classification uses temporal criteria and does not establish a well-defined strategy to characterize the individual-specific degree of atrial cardiomyopathy. Better characterization of atrial cardiomyopathy may improve the decision-making process on the most appropriate therapeutic option. We review current scientific evidence and propose a practical characterization of the atrial substrate based on 3 evaluation steps starting with a clinical evaluation (step 1), then assess outpatient complementary data (step 2), and finally include information from advanced diagnostic tools (step 3). The information from each of the steps or a combination thereof can be used to classify AF patients in 4 stages of atrial cardiomyopathy, which we also use to estimate the success on effective rhythm control.
心房颤动（AF）可导致心房的进行性结构和电生理改变，这些改变可用心房重构的一般概念来概括。同时，其他临床特征和合并症也可能影响心房组织特性，使心房容易发生 AF 发作和长期持续。总之，病理性心房改变导致心房心肌病，这对节律控制具有重要意义。尽管人们普遍认为心房基质在 AF 节律控制中的作用，但目前的分类过于简单化了临床管理。该分类使用时间标准，并没有制定明确的策略来描述个体特有的心房心肌病程度。更好地描述心房心肌病可能会改善对最合适治疗选择的决策过程。我们回顾了当前的科学证据，并提出了一种基于 3 个评估步骤的实用的心房基质特征描述方法，从临床评估（第 1 步）开始，然后评估门诊补充数据（第 2 步），最后纳入高级诊断工具的信息（第 3 步）。每一步或其组合的信息可用于将 AF 患者分为 4 个阶段的心房心肌病，我们还使用这些信息来估计有效的节律控制的成功率。
