title: Novel mechanisms in the pathogenesis of atrial fibrillation: practical applications.
abstract: Intensive research over the last few decades has seen significant advances in our understanding of the complex mechanisms underlying atrial fibrillation (AF). The epidemic of AF and related hospitalizations has been described as a 'rising tide' with estimates of the global AF burden showing no sign of retreat. There is urgency for effective translational programs in this field to facilitate more individualized and targeted therapy to modify the abnormal atrial substrate responsible for the perpetuation of this arrhythmia. In this review, we chose to focus on several novel aspects of AF pathogenesis whereby practical applications in clinical practice are currently available or potentially not too far away. Specifically, we explored the contribution of atrial fibrosis, epicardial adipose tissue, autonomic nervous system, hyper-coagulability, and focal drivers to adverse atrial remodelling and AF persistence. We also highlighted the potential practical means of monitoring and targeting these factors to achieve better outcomes in patients suffering from this debilitating illness. Emerging data also support a new paradigm for targeting AF substrate with aggressive risk factor management. Finally, multi-disciplinary integrated care approach has shown great promise in improving cardiovascular outcomes of patients with AF along with potential cost savings.
authors.affiliation: Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.
authors.forename: Dennis H
authors.initials: DH
authors.lastname: Lau
authors.affiliation: Department of Physiology, Maastricht University, Maastricht, The Netherlands.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Schotten
authors.affiliation: Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Mahajan
authors.affiliation: Adelaide Institute for Sleep Health, Repatriation General Hospital and Department of Medicine, Flinders University, Adelaide, Australia.
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Antic
authors.affiliation: Department of Cardiology, Assistance Publique - Hôpitaux de Paris, Pitié-Salpêtrière Hospital and Institute of Cardiometabolism and Nutrition, Sorbonne Université, INSERM UMR S1166, Paris, France.
authors.forename: Stéphane N
authors.initials: SN
authors.lastname: Hatem
authors.affiliation: Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.
authors.forename: Rajeev K
authors.initials: RK
authors.lastname: Pathak
authors.affiliation: Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: Jeroen M L
authors.initials: JM
authors.lastname: Hendriks
authors.affiliation: Department of Cardiology, Royal Melbourne Hospital and the Department of Medicine, University of Melbourne, Melbourne, Australia.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Kalman
authors.affiliation: Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia prash.sanders@adelaide.edu.au.
authors.forename: Prashanthan
authors.initials: P
authors.lastname: Sanders
mesh_terms: D001281:Atrial Fibrillation; D064752:Atrial Remodeling; D005355:Fibrosis; D006325:Heart Atria; D006801:Humans; D010496:Pericardium
keywords: Atrial fibrillation; Integrated care; Mechanisms; Pathogenesis; Risk factor management; Substrate