PMID: 16528961Mar 15, 2006Paper

Atrail fibrillation and heart failure: a complex relationship

Giornale italiano di cardiologia : organo ufficiale della Federazione italiana di cardiologia : organo ufficiale della Società italiana di chirurgia cardiaca
Marcello CostantiniGianni Sticchi

Abstract

Atrial fibrillation (AF) and heart failure (HF) often coexist in the same patient, not only because they can result from the same heart disease, but also because each of them can directly lead to the other. In the genesis of AF, structural, electrical and functional factors share a key role, but the importance of any of them is variable, according to the different clinical situations. AF causes atrial changes, electrical, anatomical or both, that can result in maintenance, recurrence and even irreversibility of the arrhythmia. In addition, AF affects the ventricular function by: a) loss of atrioventricular synchrony; b) irregular ventricular response; c) rapid ventricular response, possibly leading to tachycardia-induced cardiomyopathy. AF, thus, can "beget" HF, even in subjects with a previously normal heart. On the other hand, HF often "begets" AF. The prevalence of AF in patients with HF, indeed, increases from 5% (NYHA class I) to 50% (NYHA class IV). The mechanisms of HF-induced AF, include: a) increase of "critical atrial mass"; b) atrial stretch, with mechanoelectrical feedback; c) neuroendocrine changes; and d) extracellular matrix fibrosis. In brief, there is an important association between HF and development of AF an...Continue Reading

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