The perplexing complexity of cardiac arrhythmias: beyond electrical remodeling.
Cardiac arrhythmias continue to pose a major medical challenge and significant public health burden. Atrial fibrillation, the most prevalent arrhythmia, affects more than two million Americans annually and is associated with a twofold increase in mortality. In addition, more than 250,000 Americans each year suffer ventricular arrhythmias, often resulting in sudden cardiac death. Despite the high incidence and societal impact of cardiac arrhythmias, presently there are insufficient insights into the molecular mechanisms involved in arrhythmia generation, propagation, and/or maintenance or into the molecular determinants of disease risk, prognosis, and progression. In addition, present therapeutic strategies for arrhythmia abatement often are ineffective or require palliative device therapy after persistent changes in the electrical and conduction characteristics of the heart have occurred, changes that appear to increase the risk for arrhythmia progression. This article reviews our present understanding of the complexity of mechanisms that regulate cardiac membrane excitability and cardiac function and explores the role of derangements in these mechanisms that interact to induce arrhythmogenic substrates. Approaches are recommended for future investigations focused on providing new mechanistic insights and therapeutic interventions.
Adamson
Philip B
PB
University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
Barr
Roger C
RC
Callans
David J
DJ
Chen
Peng-Sheng
PS
Lathrop
David A
DA
Makielski
Jonathan C
JC
Nerbonne
Jeanne M
JM
Nuss
H Bradley
HB
Olgin
Jeffrey E
JE
Przywara
Dennis A
DA
Rosen
Michael R
MR
Rozanski
George J
GJ
Spach
Madison S
MS
Yamada
Kathryn A
KA
D001145:Arrhythmias, Cardiac / Q000235:genetics / Q000503:physiopathology*; D018450:Disease Progression; D005109:Extracellular Matrix / Q000502:physiology; D006329:Heart Conduction System / Q000502:physiology*; D006801:Humans; D007473:Ion Channels / Q000502:physiology; D011379:Prognosis; D020257:Ventricular Remodeling / Q000502:physiology
D007473:Ion Channels