New ideas about atrial fibrillation 50 years on


Atrial fibrillation is a condition in which control of heart rhythm is taken away from the normal sinus node pacemaker by rapid activity in different areas within the upper chambers (atria) of the heart. This results in rapid and irregular atrial activity and, instead of contracting, the atria only quiver. It is the most common cardiac rhythm disturbance and contributes substantially to cardiac morbidity and mortality. For over 50 years, the prevailing model of atrial fibrillation involved multiple simultaneous re-entrant waves, but in light of new discoveries this hypothesis is now undergoing re-evaluation.

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Figure 1: Diagram of electrical activity during atrial fibrillation.
Figure 2: Cellular mechanisms of atrial arrhythmia generation.
Figure 3: Conceptual models of atrial fibrillation in the early twentieth century, along with therapeutic implications.
Figure 4: Models of re-entry and implications for atrial fibrillation.
Figure 5: Ionic determinants of atrial fibrillation.
Figure 6: Changes in cell Ca2+ loading caused by atrial fibrillation and consequent adaptive responses.
Figure 7: A synthesis of recent advances in our knowledge of the substrates for atrial fibrillation.


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Nattel, S. New ideas about atrial fibrillation 50 years on. Nature 415, 219–226 (2002).

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