Towards mechanism-directed electrophenotype-based treatments for atrial fibrillation
File(s)fphys-11-00987.pdf (1.55 MB)
Published version
Author(s)
Ng, FS
Handa, B
Li, X
Peters, N
Type
Journal Article
Abstract
Current treatment approaches for persistent atrial fibrillation (AF) have a ceiling of success of around 50%. This is despite 15 years of developing adjunctive ablation strategies in addition to pulmonary vein isolation to target the underlying arrhythmogenic substrate in AF. A major shortcoming of our current approach to AF treatment is its predominantly empirical nature. This has in part been due to a lack of consensus on the mechanisms that sustain human AF.6 In this article, we review evidence suggesting that the previous debates on AF being eitheran organised arrhythmia with a focal driver ora disorganised rhythm sustained by multiple wavelets, may prove to be a false dichotomy. Instead,a range of fibrillation electrophenotypes exists along a continuous spectrum, and the predominant mechanism in an individual case is determined by the nature and extent of remodelling of the underlying substrate. We propose moving beyond the current empirical approach to AF treatment, and highlight the need to prescribe AF treatments based on the underlying AFelectrophenotype, and review several possible novel mapping algorithms that may be useful in discerning the AF electrophenotype to guide tailored treatments, including Granger Causality mapping.
Date Issued
2020-08-28
Date Acceptance
2020-07-20
ISSN
1664-042X
Publisher
Frontiers Media
Start Page
1
End Page
7
Journal / Book Title
Frontiers in Physiology
Volume
11
Copyright Statement
© 2020 Ng, Handa, Li and Peters. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) http://creativecommons.org/licenses/by/4.0/. The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
Sponsor
British Heart Foundation
Rosetrees Trust
Rosetrees Trust
Imperial College Healthcare NHS Trust- BRC Funding
Imperial College Healthcare NHS Trust- BRC Funding
British Heart Foundation
British Heart Foundation
Identifier
https://www.frontiersin.org/articles/10.3389/fphys.2020.00987/full
Grant Number
RG/16/3/32175
A1173/ M577
A1407/ M645
RDB02
RDB02
RE/18/4/34215
RG/16/3/32175
Subjects
Science & Technology
Life Sciences & Biomedicine
Physiology
atrial fibrilation (AF)
fibrillation
ablation
mapping
Granger analyses
CATHETER ABLATION
CHANNEL BLOCKADE
PERSISTENT
DYNAMICS
TERMINATION
CONDUCTION
INITIATION
Granger analyses
ablation
atrial fibrilation (AF)
fibrillation
mapping
0606 Physiology
1116 Medical Physiology
1701 Psychology
Publication Status
Published
Article Number
987
Date Publish Online
2020-08-28