Mitochondria and the Pathophysiological Mechanism of Atrial Fibrillation

2018 ◽  
Vol 24 (26) ◽  
pp. 3055-3061 ◽  
Author(s):  
Xinye Li ◽  
Xinyu Yang ◽  
Yanda Li ◽  
Mengchen Yuan ◽  
Chao Tian ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Practice ◽  
Anticancer Agents ◽  
Treatment Options ◽  
Management Strategies ◽  
Pathophysiological Mechanism ◽  
Treatment And Prevention ◽  
Close Relationship ◽  
Mitochondrial Distribution ◽  
Transfer Chain

Atrial fibrillation (AF) is the most common and significant cardiac arrhythmia in clinical practice, however the pathophysiological mechanism of AF has not been fully explained. At present, there are no available treatment options that can target the underlying pathophysiological processes of AF. Research on improving management strategies for AF can start with a further understanding of the changes of cells in AF. Mitochondria play central roles in the function of cardiac myocytes and many of the pathophysiological processes implicated in AF are relative to mitochondrial function, including formation of reactive oxygen species (ROS), calcium homeostasis, and alterations of oxygen consumption. The changes of levels of phosphocreatine, electron transfer chain proteins and differences in mitochondrial distribution further imply that mitochondria play a role in AF. Related studies of recent years are summarized, in order to elucidate the causal relationship between mitochondria and AF, and provide potential therapeutic target for the treatment and prevention of AF in clinical practice. In the article, we summarize the direct or indirect factors that affect mitochondria function and thus cause AF, including anticancer agents, surgery, gene, age, air pollution, oxidative stress, and β3-adrenoceptor (β3-AR). There is a close relationship between mitochondrial dysfunction and the occurrence of AF, which cannot be ignored, and further research in this area is needed.

Thrombosis and Cancer: Emerging Data for the Practicing Oncologist

2013 ◽  
pp. e337-e345 ◽  
Author(s):  
Gary H. Lyman ◽  
Alok A. Khorana ◽  
Anna Falanga
Keyword(s):  
Risk Factors ◽  
Clinical Practice ◽  
Venous Thromboembolism ◽  
Practice Guidelines ◽  
Malignant Disease ◽  
Patients With Cancer ◽  
Treatment And Prevention ◽  
Close Relationship ◽  
Specific Factors ◽  
American Society

The American Society of Clinical Oncology (ASCO) recently updated clinical practice guidelines on the treatment and prevention of venous thromboembolism (VTE) in patients with cancer. Although several new studies have been reported, many questions remain about the close relationship between VTE and malignant disease. The risk of VTE among patients with cancer continues to increase and is clearly linked to patient-, disease- and treatment-specific factors. In general, VTE among patients with cancer is treated in a similar fashion to that in other patient populations. However, the greater risk of VTE in patients with cancer, the multitude of risk factors, and the greater risk of VTE recurrence and mortality among patients with cancer pose important challenges for surgeons, oncologists, and other providers.

scholarly journals Comparison of Atrial Fibrillation in the Young versus That in the Elderly: A Review

2013 ◽  
Vol 2013 ◽  
pp. 1-16 ◽  
Author(s):  
Rajiv Sankaranarayanan ◽  
Graeme Kirkwood ◽  
Katharine Dibb ◽  
Clifford J. Garratt
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Treatment Options ◽  
Management Strategies ◽  
Young Patients ◽  
Patient Characteristics ◽  
The Elderly ◽  
Diagnostic Techniques ◽  
Significant Burden ◽  
Acting In Concert

The incidence and prevalence of atrial fibrillation (AF) are projected to increase significantly worldwide, imposing a significant burden on healthcare resources. The disease itself is extremely heterogeneous in its epidemiology, pathophysiology, and treatment options based on individual patient characteristics. Whilst ageing is well recognised to be an independent risk factor for the development of AF, this condition also affects the young in whom the condition is frequently symptomatic and troublesome. Traditional thinking suggests that the causal factors and pathogenesis of the condition in the young with structurally normal atria but electrophysiological “triggers” in the form of pulmonary vein ectopics leading to lone AF are in stark contrast to that in the elderly who have AF primarily due to an abnormal substrate consisting of fibrosed and dilated atria acting in concert with the pulmonary vein triggers. However, there can be exceptions to this rule as there is increasing evidence of structural and electrophysiological abnormalities in the atrial substrate in young patients with “lone AF,” as well as elderly patients who present with idiopathic AF. These reports seem to be blurring the distinction in the pathophysiology of so-called idiopathic lone AF in the young versus that in the elderly. Moreover with availability of improved and modern investigational and diagnostic techniques, novel causes of AF are being reported thereby seemingly consigning the diagnosis of “lone AF” to a rather mythical existence. We shall also elucidate in this paper the differences seen in the epidemiology, causes, pathogenesis, and clinical features of AF in the young versus that seen in the elderly, thereby requiring clearly defined management strategies to tackle this arrhythmia and its associated consequences.

Health professional consultation and use of conservative management strategies in patients with knee or hip osteoarthritis awaiting orthopaedic consultation

2014 ◽  
Vol 20 (3) ◽  
pp. 305 ◽  
Author(s):  
Robin Haskins ◽  
Judith M. Henderson ◽  
Nikolai Bogduk
Keyword(s):  
Clinical Practice ◽  
Conservative Management ◽  
Treatment Options ◽  
Management Strategies ◽  
Hip Osteoarthritis ◽  
Guideline Recommendation ◽  
Implementation Framework ◽  
Pharmacological Management ◽  
Knee Oa ◽  
National Implementation

The aim of this study was to determine the extent to which patients with hip and knee osteoarthritis (OA) referred for orthopaedic consultation at a large Australian public hospital reported using conservative management strategies as recommended by current practice guidelines. A therapist-assisted questionnaire was employed within the context of a standard physiotherapy assessment in a consecutive cohort of patients with hip or knee OA. Two hundred and two patients with hip or knee OA comprised the included sample. Thirty-nine percent (n = 79) reported having only previously consulted their general practitioner. Only 20% (n = 41) felt that they had been sufficiently educated about the diagnosis, their treatment options and prognosis. Thirty-three percent (n = 66) had not previously engaged in any non-pharmacological management strategy considered a core clinical practice guideline recommendation. The findings of this study suggest that several inconsistencies may exist between current Australian clinical practice and OA clinical guideline recommendations. Identification of the barriers to the use of conservative management requires timely investigation coupled with a national implementation framework to support the translation of guideline recommendations into practice.

scholarly journals The 4S-AF Scheme (Stroke Risk; Symptoms; Severity of Burden; Substrate): A Novel Approach to In-Depth Characterization (Rather than Classification) of Atrial Fibrillation

2020 ◽  
Author(s):  
Tatjana S. Potpara ◽  
Gregory Y. H. Lip ◽  
Carina Blomstrom-Lundqvist ◽  
Giuseppe Boriani ◽  
Isabelle C. Van Gelder ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Decision Making ◽  
Clinical Practice ◽  
Stroke Risk ◽  
Treatment Options ◽  
Symptom Control ◽  
Treatment Decision ◽  
Treatment Decisions ◽  
Treatment Decision Making

AbstractAtrial fibrillation (AF) is a complex condition requiring holistic management with multiple treatment decisions about optimal thromboprophylaxis, symptom control (and prevention of AF progression), and identification and management of concomitant cardiovascular risk factors and comorbidity. Sometimes the information needed for treatment decisions is incomplete, as available classifications of AF mostly address a single domain of AF (or patient)-related characteristics. The most widely used classification of AF based on AF episode duration and temporal patterns (that is, the classification to first-diagnosed, paroxysmal, persistent/long-standing persistent, and permanent AF) has contributed to a better understanding of AF prevention and treatment but its limitations and the need for a multidimensional AF classification have been recognized as more complex treatment options became available. We propose a paradigm shift from classification toward a structured characterization of AF, addressing specific domains having treatment and prognostic implications to become a standard in clinical practice, thus aiming to streamline the assessment of AF patients at all health care levels facilitating communication among physicians, treatment decision-making, and optimal risk evaluation and management of AF patients. Specifically, we propose the 4S-AF structured pathophysiology-based characterization (rather than classification) scheme that includes four AF- and patient-related domains—Stroke risk, Symptoms, Severity of AF burden, and Substrate severity—and provide a hypothetical model for the use of 4S-AF characterization scheme to aid treatment decision making concerning the management of patients with AF in clinical practice.

Cohort profile The ESC EURObservational Research Programme Atrial Fibrillation III (AF III) Registry

2020 ◽  
Author(s):  
Tatjana S Potpara ◽  
Gregory Y H Lip ◽  
Nikolaos Dagres ◽  
Harry J M G Crijns ◽  
Giuseppe Boriani ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Practice ◽  
Guideline Implementation ◽  
Management Strategies ◽  
Bleeding Event ◽  
Research Programme ◽  
Routine Practice ◽  
Life Questionnaire ◽  
Guidelines Implementation ◽  
European Society Of Cardiology

Abstract Aims The European Society of Cardiology (ESC) EURObservational Research Programme (EORP)-Atrial Fibrillation (AF) III Registry aims to identify contemporary patterns in AF management in clinical practice, assess their compliance with the 2016 ESC AF Guidelines, identify major gaps in guideline implementation, characterize the clinical practice settings associated with good versus poor guideline implementation and assess and compare the 1-year outcome of guideline-adherent versus guideline non-adherent management strategies Methods and Results Consecutive adult AF patients (n=8306) were enrolled between July 1st, 2018 and July 15th, 2019, and individual patient data were prospectively collected across 192 centres and 31 participating countries during the 3-month enrolment period per centre. The Registry collected baseline and 1-year follow-up data in the 8 main domains: patient demographic/enrolment setting, AF diagnosis/characterization, diagnostic assessment, stroke prevention treatments, arrhythmia-directed therapies, integrated AF management, major outcomes (death, non-fatal stroke or systemic embolic event, non-fatal bleeding event) and the quality of life questionnaire. Conclusion The EORP-AF III Registry is an international, prospective registry of care and outcomes of patients treated for AF, which will provide insights into the contemporary patterns in AF management, ESC AF Guidelines implementation in routine practice and barriers to optimal management of this highly prevalent arrhythmia.

scholarly journals Management strategies for atrial fibrillation

2017 ◽  
Vol 110 (1) ◽  
pp. 13-22 ◽  
Author(s):  
Peysh A Patel ◽  
Noman Ali ◽  
Andrew Hogarth ◽  
Muzahir H Tayebjee
Keyword(s):  
Atrial Fibrillation ◽  
Oral Anticoagulants ◽  
Treatment Options ◽  
Management Strategies ◽  
Novel Oral Anticoagulants ◽  
Bleeding Complications ◽  
Comparable Efficacy ◽  
Suitable Alternative ◽  
Independent Prognostic Marker ◽  
Multiple Treatment

Atrial fibrillation is the most prevalent cardiac arrhythmia, affecting 10% of those aged over 80 years. Despite multiple treatment options, it remains an independent prognostic marker of mortality due to its association with clinical sequelae, particularly cerebrovascular events. Management can be broadly divided into treatment of the arrhythmia, via rhythm or rate control, and stroke thromboprophylaxis via anticoagulation. Traditional options for pharmacotherapy include negatively chronotropic drugs such as β-blockers, and/or arrhythmia-modifying drugs such as amiodarone. More recently, catheter ablation has emerged as a suitable alternative for selected patients. Additionally, there has been extensive research to assess the role of novel oral anticoagulants as alternatives to warfarin therapy. There is mounting evidence to suggest that they provide comparable efficacy, while being associated with lower bleeding complications. While these findings are promising, recent controversies have arisen with the use of novel oral anticoagulants. Further research is warranted to fully elucidate mechanisms and establish antidotes so that treatment options can be appropriately directed.

scholarly journals LEFT ATRIAL APPENDAGE MANAGEMENT: A SURGICAL PERSPECTIVE

2021 ◽  
Author(s):  
Fabrizio Rosati ◽  
Gijs de Maat ◽  
Massimo Mariani ◽  
Stefano Benussi
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Thrombus Formation ◽  
Treatment Options ◽  
Management Strategies ◽  
Atrial Appendage ◽  
Epicardial Ablation ◽  
Invasive Treatment ◽  
Surgical Aspects

Atrial fibrillation (AF) is the most common atrial arrhythmia but it is not a benign disease. AF is an important risk factor for thromboembolic events, causing significant morbidity and mortality. The left atrial appendage (LAA) plays an important role in thrombus formation but the ideal way to manage the LAA is still debated. The increasing popularity of surgical epicardial ablation and hybrid endo-epicardial ablation approaches, especially in patients with a more advanced diseased substrate, has raised the interest in epicardial LAA management. Minimally invasive treatment options for the LAA offer a unique opportunity to close the LAA with a clip device. This review highlights morphologic, electrophysiologic and surgical aspects of the left atrial appendage with regard to atrial fibrillation surgery, and aims to illustrate the different surgical management strategies.

scholarly journals Atrial Fibrillation Management Strategies in Routine Clinical Practice: Insights from the International RealiseAF Survey

PLoS ONE ◽  
2016 ◽  
Vol 11 (1) ◽  
pp. e0147536 ◽  
Author(s):  
Chern-En Chiang ◽  
Lisa Naditch-Brûlé ◽  
Sandrine Brette ◽  
José Silva-Cardoso ◽  
Habib Gamra ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Practice ◽  
Management Strategies ◽  
Routine Clinical Practice

A Genomic Approach to Characterize the Vulnerable Patient – a Clinical Update

2019 ◽  
Vol 4 (3) ◽  
pp. 141-144
Author(s):  
Evelin Szabó ◽  
Zsolt Parajkó ◽  
Diana Opincariu ◽  
Monica Chițu ◽  
Nóra Raț ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Ischemia ◽  
Treatment Options ◽  
Ischemic Heart ◽  
Pathophysiological Mechanism ◽  
Ischemia And Reperfusion Injury ◽  
Myocardial Ischemia And Reperfusion ◽  
Vulnerable Patient ◽  
Traditional Risk Factors ◽  
New Treatment

Abstract Atherosclerosis is the elemental precondition for any cardiovascular disease and the predominant cause of ischemic heart disease that often leads to myocardial infarction. Systemic risk factors play an important role in the starting and progression of atherosclerosis. The complexity of the disease is caused by its multifactorial origin. Besides the traditional risk factors, genetic predisposition is also a strong risk factor. Many studies have intensively researched cardioprotective drugs, which can relieve myocardial ischemia and reperfusion injury, thereby reducing infarct size. A better understanding of abnormal epigenetic pathways in the myocardial pathology may result in new treatment options. Individualized therapy based on genome sequencing is important for an effective future medical treatment. Studies based on multiomics help to better understand the pathophysiological mechanism of several diseases at a molecular level. Epigenomic, transcriptomic, proteomic, and metabolomic research may be essential in detecting the pathological phenotype of myocardial ischemia and ischemic heart failure.

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