Cargando…
Calcium in the Pathophysiology of Atrial Fibrillation and Heart Failure
Atrial fibrillation (AF) is commonly associated with heart failure. A bidirectional relationship exists between the two—AF exacerbates heart failure causing a significant increase in heart failure symptoms, admissions to hospital and cardiovascular death, while pathological remodeling of the atria a...
Autores principales: | , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2018
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6180171/ https://www.ncbi.nlm.nih.gov/pubmed/30337881 http://dx.doi.org/10.3389/fphys.2018.01380 |
_version_ | 1783362145151352832 |
---|---|
author | Denham, Nathan C. Pearman, Charles M. Caldwell, Jessica L. Madders, George W. P. Eisner, David A. Trafford, Andrew W. Dibb, Katharine M. |
author_facet | Denham, Nathan C. Pearman, Charles M. Caldwell, Jessica L. Madders, George W. P. Eisner, David A. Trafford, Andrew W. Dibb, Katharine M. |
author_sort | Denham, Nathan C. |
collection | PubMed |
description | Atrial fibrillation (AF) is commonly associated with heart failure. A bidirectional relationship exists between the two—AF exacerbates heart failure causing a significant increase in heart failure symptoms, admissions to hospital and cardiovascular death, while pathological remodeling of the atria as a result of heart failure increases the risk of AF. A comprehensive understanding of the pathophysiology of AF is essential if we are to break this vicious circle. In this review, the latest evidence will be presented showing a fundamental role for calcium in both the induction and maintenance of AF. After outlining atrial electrophysiology and calcium handling, the role of calcium-dependent afterdepolarizations and atrial repolarization alternans in triggering AF will be considered. The atrial response to rapid stimulation will be discussed, including the short-term protection from calcium overload in the form of calcium signaling silencing and the eventual progression to diastolic calcium leak causing afterdepolarizations and the development of an electrical substrate that perpetuates AF. The role of calcium in the bidirectional relationship between heart failure and AF will then be covered. The effects of heart failure on atrial calcium handling that promote AF will be reviewed, including effects on both atrial myocytes and the pulmonary veins, before the aspects of AF which exacerbate heart failure are discussed. Finally, the limitations of human and animal studies will be explored allowing contextualization of what are sometimes discordant results. |
format | Online Article Text |
id | pubmed-6180171 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-61801712018-10-18 Calcium in the Pathophysiology of Atrial Fibrillation and Heart Failure Denham, Nathan C. Pearman, Charles M. Caldwell, Jessica L. Madders, George W. P. Eisner, David A. Trafford, Andrew W. Dibb, Katharine M. Front Physiol Physiology Atrial fibrillation (AF) is commonly associated with heart failure. A bidirectional relationship exists between the two—AF exacerbates heart failure causing a significant increase in heart failure symptoms, admissions to hospital and cardiovascular death, while pathological remodeling of the atria as a result of heart failure increases the risk of AF. A comprehensive understanding of the pathophysiology of AF is essential if we are to break this vicious circle. In this review, the latest evidence will be presented showing a fundamental role for calcium in both the induction and maintenance of AF. After outlining atrial electrophysiology and calcium handling, the role of calcium-dependent afterdepolarizations and atrial repolarization alternans in triggering AF will be considered. The atrial response to rapid stimulation will be discussed, including the short-term protection from calcium overload in the form of calcium signaling silencing and the eventual progression to diastolic calcium leak causing afterdepolarizations and the development of an electrical substrate that perpetuates AF. The role of calcium in the bidirectional relationship between heart failure and AF will then be covered. The effects of heart failure on atrial calcium handling that promote AF will be reviewed, including effects on both atrial myocytes and the pulmonary veins, before the aspects of AF which exacerbate heart failure are discussed. Finally, the limitations of human and animal studies will be explored allowing contextualization of what are sometimes discordant results. Frontiers Media S.A. 2018-10-04 /pmc/articles/PMC6180171/ /pubmed/30337881 http://dx.doi.org/10.3389/fphys.2018.01380 Text en Copyright © 2018 Denham, Pearman, Caldwell, Madders, Eisner, Trafford and Dibb. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). 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. |
spellingShingle | Physiology Denham, Nathan C. Pearman, Charles M. Caldwell, Jessica L. Madders, George W. P. Eisner, David A. Trafford, Andrew W. Dibb, Katharine M. Calcium in the Pathophysiology of Atrial Fibrillation and Heart Failure |
title | Calcium in the Pathophysiology of Atrial Fibrillation and Heart Failure |
title_full | Calcium in the Pathophysiology of Atrial Fibrillation and Heart Failure |
title_fullStr | Calcium in the Pathophysiology of Atrial Fibrillation and Heart Failure |
title_full_unstemmed | Calcium in the Pathophysiology of Atrial Fibrillation and Heart Failure |
title_short | Calcium in the Pathophysiology of Atrial Fibrillation and Heart Failure |
title_sort | calcium in the pathophysiology of atrial fibrillation and heart failure |
topic | Physiology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6180171/ https://www.ncbi.nlm.nih.gov/pubmed/30337881 http://dx.doi.org/10.3389/fphys.2018.01380 |
work_keys_str_mv | AT denhamnathanc calciuminthepathophysiologyofatrialfibrillationandheartfailure AT pearmancharlesm calciuminthepathophysiologyofatrialfibrillationandheartfailure AT caldwelljessical calciuminthepathophysiologyofatrialfibrillationandheartfailure AT maddersgeorgewp calciuminthepathophysiologyofatrialfibrillationandheartfailure AT eisnerdavida calciuminthepathophysiologyofatrialfibrillationandheartfailure AT traffordandreww calciuminthepathophysiologyofatrialfibrillationandheartfailure AT dibbkatharinem calciuminthepathophysiologyofatrialfibrillationandheartfailure |