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Mechanisms of postcardiac surgery atrial fibrillation: more pieces in a difficult puzzle

Authors
Publisher
Elsevier
Publication Date
Keywords
  • Rc Internal Medicine
Disciplines
  • Biology
  • Medicine

Abstract

Microsoft Word - 091028 Workman, Puzzle ed, as accepted [to Enlighten] Workman, A.J. (2009) Mechanisms of postcardiac surgery atrial fibrillation: more pieces in a difficult puzzle. Heart Rhythm, 6 (10). pp. 1423-1424. ISSN 1547-5271 http://eprints.gla.ac.uk/7847/ Deposited on: 29 October 2009 Enlighten – Research publications by members of the University of Glasgow http://eprints.gla.ac.uk 1/4 Mechanisms of post-cardiac surgery atrial fibrillation: more pieces in a difficult puzzle Antony J Workman, PhD. �: [email protected] British Heart Foundation Glasgow Cardiovascular Research Centre, Division of Cardiovascular & Medical Sciences, Faculty of Medicine, University of Glasgow, 126 University Place, Glasgow G12 8TA, UK Atrial fibrillation (AF) is common following cardiac surgery, affecting ~30% of patients. It is associated with increased morbidity and mortality. Various anti-arrhythmic drugs reduce the incidence of post-surgery AF, 1 but they also carry considerable potential for adverse effects. The development of safer and more effective treatments for this arrhythmia will require an improved understanding of its basic electrophysio- logical mechanisms. A variety of reentrant and non-reentrant arrhythmia mechanisms likely initiates and sustains AF. 2 Which of these predominate is unclear, and may depend on, e.g., underlying cardiac pathology, autonomic tone, and whether AF is paroxysmal or sustained. Atrial activation frequency characteristics have been studied during AF with spectral analysis using fast Fourier transformations. This technique provides clues as to the source of AF and its level of organisation. In patients with AF, the dominant frequency (DF) of activation was higher in the left atrium (LA) than right (RA), suggesting that the source of AF was located primarily in LA. 3 Studies in sheep suggested that such LA sources could be reentrant. This is because acetylcho

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