REVIEW   

Minerva Cardioangiologica 2017 April;65(2):157-72

DOI: 10.23736/S0026-4725.16.04167-0

Copyright © 2016 EDIZIONI MINERVA MEDICA

language: English

Biophysical aspects and novel treatments of atrial fibrillation

Lorenzo GIGLI ¹, Gian M. ROSA ¹, Maria I. TAGLIASACCHI ¹, Aldo BONAVENTURA ², Luca LIBERALE ², Fabrizio MONTECUCCO ^{2, 3, 4}, Federico CARBONE ², Giovanni BERTERO ¹, Claudio BRUNELLI ¹ ✉

¹ Department of Cardiology, IRCCS S. Martino Hospital, University of Genoa, Genoa, Italy; ² Department of Internal Medicine, First Clinic of Internal Medicine, University of Genoa, Genoa, Italy; ³ IRCCS AOU San Martino-IST, Genoa, Italy; ⁴ Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy

INTRODUCTION: Atrial fibrillation (AF) is a cardiac arrhythmia caused by various mechanisms, such as multiple re-entering wavelets, high frequency activity, and rotor sources.
EVIDENCE ACQUISITION: This narrative review was based on papers found on PubMed and MEDLINE up to May 2016. The search terms were “atrial fibrillation” in combination with “catheter ablation, pathophysiology, antiarrhythmic drugs”.
EVIDENCE SYNTHESIS: Antiarrhythmic drugs are the cornerstone of therapy in AF, but their efficacy and safety might have to be improved. In case of failure of pharmacologic therapies, other treatments can be considered. A better understanding of the important role of the pulmonary veins has led to new approaches, such as ablation procedures, which were initially only surgical, while percutaneous options were later added. However, these strategies may present various technical complications also when performed by skilled operators. A promising field of investigation is the genetics of AF, as highlighted by studies on the role of micro-RNA.
CONCLUSIONS: Relevant improvement on the knowledge of the electrophysiological basis of genesis and maintenance of AF has been done in order to treat a very common arrhythmia, but further studies, as those in the genetics field, can open new challenging therapeutic horizons.

KEY WORDS: Arrhythmias, cardiac - Electrophysiology - Anti-arrhythmia agents - Catheter ablation