医学
心房颤动
再入
心脏病学
人口
心律失常
病理生理学
内科学
神经科学
重症监护医学
生物
环境卫生
作者
Yu‐ki Iwasaki,Kunihiro Nishida,Takeshi Kato,Stanley Nattel
出处
期刊:Circulation
[Ovid Technologies (Wolters Kluwer)]
日期:2011-11-15
卷期号:124 (20): 2264-2274
被引量:699
标识
DOI:10.1161/circulationaha.111.019893
摘要
Atrial fibrillation (AF), the most common sustained cardiac arrhythmia, is an important contributor to population morbidity and mortality. An arrhythmia that is particularly common in the elderly, AF is growing in prevalence with the aging of the population. Our understanding of the basic mechanisms that govern AF occurrence and persistence has been increasing rapidly. This article reviews the basic pathophysiology of AF over a broad range of levels, touching on the tissue mechanisms that maintain the arrhythmia, the relationship between clinical presentation and basic mechanisms, ion channel and transporter abnormalities that lead to ectopic impulse formation, basic models and tissue determinants of reentry, ion channel determinants of reentry, the nature and roles of electric and structural remodeling, autonomic neural components, anatomic factors, interactions between atrial and ventricular functional consequences of AF, and the basic determinants of atrial thromboembolism. We then review the potential implications of the basic pathophysiology of the arrhythmia for its management. We first discuss consequences for improved rhythm control pharmacotherapy: targeting underlying conditions, new atrium-selective drug targets, new targets for focal ectopic source suppression, and upstream therapy aiming to prevent remodeling. We then review the implications of basic mechanistic considerations for rate control therapy, AF ablation, and the prevention of thromboembolic events. We conclude with some thoughts about the future of translational research related to AF mechanisms.
科研通智能强力驱动
Strongly Powered by AbleSci AI