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Atrial fibrillation (AF) is the most common sustained clinical arrhythmia and is associated with significant morbidity, mostly secondary to heart failure and stroke, and an estimated two-fold increase in premature death. Efforts to increase our understanding of AF and its complications have focused on unravelling the mechanisms of electrical and structural remodelling of the atrial myocardium. Yet, it is increasingly recognized that AF is more than an atrial disease, being associated with systemic inflammation, endothelial dysfunction, and adverse effects on the structure and function of the left ventricular myocardium that may be prognostically important. Here, we review the molecular and in vivo evidence that underpins current knowledge regarding the effects of human or experimental AF on the ventricular myocardium. Potential mechanisms are explored including diffuse ventricular fibrosis, focal myocardial scarring, and impaired myocardial perfusion and perfusion reserve. The complex relationship between AF, systemic inflammation, as well as endothelial/microvascular dysfunction and the effects of AF on ventricular calcium handling and oxidative stress are also addressed. Finally, consideration is given to the clinical implications of these observations and concepts, with particular reference to rate vs. rhythm control.

Original publication

DOI

10.1093/cvr/cvv001

Type

Journal article

Journal

Cardiovasc Res

Publication Date

01/03/2015

Volume

105

Pages

238 - 247

Keywords

Atrial fibrillation, Ventricular function, Ventricular structure, Animals, Atrial Fibrillation, Atrial Function, Calcium Signaling, Coronary Circulation, Heart Atria, Heart Rate, Heart Ventricles, Humans, Inflammation Mediators, Oxidative Stress, Ventricular Function, Left, Ventricular Remodeling