Atrial remodelling and function: implications for atrial fibrillation surgery.

Benussi S; de Maat GE

doi:10.1093/ejcts/ezx340

Back

Journal article

Atrial remodelling and function: implications for atrial fibrillation surgery.

Benussi S Division of Cardiac Surgery, University Hospital Zurich, Zurich, Switzerland.
de Maat GE Department of Cardiothoracic Surgery, University Medical Centre Groningen, Groningen, Netherlands.

2018-03-29

Published in:

European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. - 2018

English The exact mechanism of atrial fibrillation (AF) is still incompletely understood. A number of alterations that impact focal electrical discharge, the atrial substrate and modulating factors contribute to its pathogenesis. Atrial remodelling (resulting in atrial cardiomyopathy) sets the stage for AF development. Once present, AF results in the loss of synchronized atrial contraction, which affects ventricular filling and atrial reservoir and conduit functions. Passive atrial function is particularly important in patients with left ventricular diastolic dysfunction. AF can cause tachycardiomyopathy, a mostly reversible cardiac alteration induced by tachycardia. At a structural level, atrial support is also instrumental to the function of atrioventricular valves. All of these functions can be recovered to variable degrees via rhythm control strategies. Surgical and hybrid ablation show very promising results, especially in patients with a more advanced disease substrate. This review highlights the pathophysiological aspects of AF related to left atrial function and their practical implications for surgical rhythm management.

Language