Genetics basis of other phenotypic components of heart failureAtrial Fibrillation in Congestive Heart Failure
Section snippets
Epidemiology
AF is the most common arrhythmia seen in clinical practice and is responsible for significant morbidity.1 More than 2.3 million individuals in the United States currently have AF,2 and as many as 5.6 to 12.1 million individuals are projected to be affected by 2050.2, 3 The lifetime risk of developing AF after age 40 is 26% for men and 23% for women.4 The presence of AF confers a fivefold increased risk of stroke,5 a significantly increased risk of dementia,6 and an almost twofold increased risk
Pathophysiology of atrial fibrillation in congestive heart failure
The pathophysiologic basis of AF is complex and incompletely understood.38 Initial mechanistic explanations for AF cited reentry as a principal factor.39, 40, 41, 42 The multiple wavelet hypothesis, proposed by Moe and Abildskov,41 stated that the development of AF depended on the perpetuation of a sufficient number of “randomly wandering wavelets” created as a normal occurrence due to heterogeneous repolarization. The hypothesis maintained that adequate atrial mass, short refractory periods,
Thromboembolism Prophylaxis
Thromboembolism prophylaxis, ventricular rate control, and restoration of sinus rhythm, when indicated, are the goals of AF therapy.1 The risk of cerebral thromboembolism in patients with AF is increased in those with CHF.31 Annual stroke risk can be estimated using validated scoring schemes,31, 120 and guidelines provide a recommended approach to the prevention of thromboembolism in patients based on their underlying risk. Generally, warfarin is advisable for the prevention of ischemic
Summary
AF and CHF share many risk factors, frequently coexist, and identify individuals at high risk of cardiovascular morbidity. The pathophysiologic mechanisms of AF in patients with CHF are complex and potentially involve elements of reentry, triggered activity, and enhanced automaticity. Therefore, it is unlikely that a treatment strategy aimed at any one of these mechanisms alone will restore sinus rhythm. A rhythm control strategy consisting of antiarrhythmic drugs and electrical cardioversion
References (142)
- et al.
Prevalence, incidence, prognosis, and predisposing conditions for atrial fibrillation: population-based estimates
Am J Cardiol
(1998) - et al.
Atrial fibrillation is associated with an increased risk for mortality and heart failure progression in patients with asymptomatic and symptomatic left ventricular systolic dysfunction: a retrospective analysis of the solved trials. Studies of left ventricular dysfunction
J Am Coll Cardiol
(1998) - et al.
Comparison of carvedilol and metoprolol on clinical outcomes in patients with chronic heart failure in the carvedilol or metoprolol european trial (comet): randomised controlled trial
Lancet
(2003) - et al.
Atrial fibrillation and risk of clinical events in chronic heart failure with and without left ventricular systolic dysfunction: results from the candesartan in heart failure-assessment of reduction in mortality and morbidity (charm) program
J Am Coll Cardiol
(2006) - et al.
Valsartan reduces the incidence of atrial fibrillation in patients with heart failure: results from the valsartan heart failure trial (val-heft)
Am Heart J
(2005) - et al.
Cardiac biopsy in patients with “primary” atrial fibrillation. Histologic evidence of occult myocardial diseases
Chest
(1991) - et al.
The hemodynamic consequences of cardiac arrhythmias: evaluation of the relative roles of abnormal atrioventricular sequencing, irregularity of ventricular rhythm and atrial fibrillation in a canine model
Am Heart J
(1983) - et al.
Hemodynamic effects of an irregular sequence of ventricular cycle lengths during atrial fibrillation
J Am Coll Cardiol
(1997) - et al.
The influence of left ventricular filling pressure on atrial contribution to cardiac output
Am Heart J
(1979) - et al.
Tachycardia-induced cardiomyopathy: a reversible form of left ventricular dysfunction
Am J Cardiol
(1986)
Atrial fibrillation as a self-sustaining arrhythmia independent of focal discharge
Am Heart J
Atrial fibrosis: mechanisms and clinical relevance in atrial fibrillation
J Am Coll Cardiol
Atrial fibrosis and the mechanisms of atrial fibrillation
Heart Rhythm
Prevention of atrial fibrillation with angiotensin-converting enzyme inhibitors and angiotensin receptor blockers: a meta-analysis
J Am Coll Cardiol
Meta-analysis: inhibition of renin-angiotensin system prevents new-onset atrial fibrillation
Am Heart J
Relation between left atrial dimension and duration of atrial fibrillation
Am J Cardiol
Role of atrial electrophysiology and autonomic nervous system in patients with supraventricular tachycardia and paroxysmal atrial fibrillation
J Am Coll Cardiol
Familial atrial fibrillation is a genetically heterogeneous disorder
J Am Coll Cardiol
A common polymorphism in scn5a is associated with lone atrial fibrillation
Clin Pharmacol Ther
Identification of a kcne2 gain-of-function mutation in patients with familial atrial fibrillation
Am J Hum Genet
A kir2.1 gain-of-function mutation underlies familial atrial fibrillation
Biochem Biophys Res Commun
Stretch-sensitive kcnq1 mutation a link between genetic and environmental factors in the pathogenesis of atrial fibrillation?
J Am Coll Cardiol
Mutation in the S3 segment of KCNQ1 results in familial lone atrial fibrillation
Heart Rhythm
Cardiac sodium channel mutation in atrial fibrillation
Heart Rhythm
A mutation in the sodium channel is responsible for the association of long QT syndrome and familial atrial fibrillation
Heart Rhythm
A novel SCN5A gain-of-function mutation M1875T associated with familial atrial fibrillation
J Am Coll Cardiol
Mapping a novel locus for familial atrial fibrillation on chromosome 10p11–q21
Heart Rhythm
Ion channel mutations in AF: signal or noise?
Heart Rhythm
ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 guidelines for the management of patients with atrial fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society
Circulation
Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the An Ticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) study
JAMA
Secular trends in incidence of atrial fibrillation in olmsted county, minnesota, 1980 to 2000, and implications on the projections for future prevalence
Circulation
Lifetime risk for development of atrial fibrillation: the Framingham heart study
Circulation
Atrial fibrillation and dementia in a population-based study. The Rotterdam study
Stroke
Incidence and mortality risk of congestive heart failure in atrial fibrillation patients: a community-based study over two decades
Eur Heart J
Increasing trends in hospitalization for atrial fibrillation in the united states, 1985 through 1999: implications for primary prevention
Circulation
Economic burden and co-morbidities of atrial fibrillation in a privately insured population
Curr Med Res Opin
Heart disease and stroke statistics—2008 update
Lifetime risk for developing congestive heart failure: the Framingham heart study
Circulation
Long-term trends in the incidence of and survival with heart failure
N Engl J Med
Trends in heart failure incidence and survival in a community-based population
JAMA
Presence and development of atrial fibrillation in chronic heart failure. Experiences from the merit-hf study
Eur J Heart Fail
Atrial fibrillation in heart failure patients: prevalence in daily practice and effect on the severity of symptoms. Data from the alpha study registry
Eur J Heart Fail
Randomized trial to determine the effect of nebivolol on mortality and cardiovascular hospital admission in elderly patients with heart failure (seniors)
Eur Heart J
Prevalence and prognostic significance of atrial fibrillation in outpatients with heart failure due to left ventricular systolic dysfunction
Eur J Heart Fail
Spontaneous conversion and maintenance of sinus rhythm by amiodarone in patients with heart failure and atrial fibrillation: observations from the veterans affairs congestive heart failure survival trial of antiarrhythmic therapy (chf-stat). The department of veterans affairs chf-stat investigators
Circulation
Prognostic relevance of atrial fibrillation in patients with chronic heart failure on long-term treatment with beta-blockers: results from comet
Eur Heart J
Outcome of heart failure with preserved ejection fraction in a population-based study
N Engl J Med
Trends in prevalence and outcome of heart failure with preserved ejection fraction
N Engl J Med
The epidemiology of heart failure: the Framingham study
J Am Coll Cardiol
Histological substrate of atrial biopsies in patients with lone atrial fibrillation
Circulation
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Dr Lubitz is supported by an NIH training grant (5T32HL007575). This work was supported by grants from the NIH: HL092577 to Drs Ellinor and Benjamin; AGO 28321 and RC1-HL01056 to Dr Benjamin; and DA027021 to Dr Ellinor. Dr Ellinor is a consultant to Sanofi-Aventis.