Atrial Myopathy

Mark J. Shen, Rishi Arora, José Jalife*

*Corresponding author for this work

Research output: Contribution to journalReview article

11 Scopus citations

Abstract

This paper discusses the evolving concept of atrial myopathy by presenting how it develops and how it affects the properties of the atria. It also reviews the complex relationships among atrial myopathy, atrial fibrillation (AF), and stroke. Finally, it discusses how to apply the concept of atrial myopathy in the clinical setting—to identify patients with atrial myopathy and to be more selective in anticoagulation in a subset of patients with AF. An apparent lack of a temporal relationship between episodes of paroxysmal AF and stroke in patients with cardiac implantable electronic devices has led investigators to search for additional factors that are responsible for AF-related strokes. Multiple animal models and human studies have revealed a close interplay of atrial myopathy, AF, and stroke via various mechanisms (e.g., aging, inflammation, oxidative stress, and stretch), which, in turn, lead to fibrosis, electrical and autonomic remodeling, and a pro-thrombotic state. The complex interplay among these mechanisms creates a vicious cycle of ever-worsening atrial myopathy and a higher risk of more sustained AF and strokes. By highlighting the importance of atrial myopathy and the risk of strokes independent of AF, this paper reviews the methods to identify patients with atrial myopathy and proposes a way to incorporate the concept of atrial myopathy to guide anticoagulation in patients with AF.

Original languageEnglish (US)
Pages (from-to)640-654
Number of pages15
JournalJACC: Basic to Translational Science
Volume4
Issue number5
DOIs
StatePublished - Sep 2019

Keywords

  • atrial fibrillation
  • atrial myopathy
  • electrophysiology
  • thrombosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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