Advances in mechanisms of atrial fibrillation: Structural remodeling, high-frequency fractionated electrograms, and reentrant AF drivers

Kevin J. Makati, Alawi A. Alsheikh-Ali, Ann C. Garlitski, Mark S. Link, Munther Homoud, Jonathan Weinstock, N. A M Estes

Research output: Contribution to journalReview article

7 Scopus citations

Abstract

The mechanisms to explain atrial fibrillation (AF) have been widely debated. Although contemporary experimental techniques have provided more insight, hypotheses regarding AF propagation conceived in the early half of the century remain minimally altered and relevant today. Modern mapping technologies have implicated multiwavelet reentry as the electrophysiologic basis to explain AF propagation within the atrial myocardium; however, reentry has also been observed within pulmonary veins and may behave as a focal trigger. The ability to terminate AF by catheter ablation has provided additional clues to explain AF induction and sustenance. The presence of complex fractionated electrograms (CFAE) and subsequent successful CFAE-directed ablation suggest that diseased atrial myocardium is a necessary substrate for AF maintenance. Atrial remodeling creates differential areas of refractory periods and conduction velocity, which, in turn, creates a suitable environment for AF. This review addresses the complex relationship between remodeled atrial myocardium and reentry and explores the role of CFAEs in AF maintenance.

Original languageEnglish (US)
Pages (from-to)45-49
Number of pages5
JournalJournal of Interventional Cardiac Electrophysiology
Volume23
Issue number1
DOIs
StatePublished - Oct 1 2008

Keywords

  • Atrial fibrillation
  • Complex fractionated electrograms
  • Reentry
  • Remodeling

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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