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Canadian Journal of Cardiology

Differential Remodeling of Late INa in Paroxysmal and Persistent AF: Another Piece in the Complex Picture of Electrical Remodelling in AF

  • Katja E. Odening
    Correspondence
    Corresponding author: Dr Katja E. Odening, Department of Physiology and Department of Cardiology, University Bern and University Hospital Bern, Buehlplatz 5, CH-3012 Bern, Switzerland.
    Affiliations
    Translational Cardiology, Department of Cardiology, Inselspital, University Hospital Bern and Department of Physiology, University of Bern, Bern, Switzerland
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Published:December 27, 2022DOI:https://doi.org/10.1016/j.cjca.2022.12.022
      Atrial fibrillation (AF), the clinically most common form of arrhythmia, is usually classified based on its duration: ranging from paroxysmal AF, consisting of self-terminating episodes lasting typically less than 7 days, to persistent and long-lasting persistent or chronic AF, in which AF fails to self-terminate.
      • Lévy S.
      • Camm A.J.
      • Saksena S.
      • et al.
      Working Group on Arrhythmias, Working Group on Cardiac Pacing of the European Society of Cardiology, North American Society of Pacing and Electrophysiology. International consensus on nomenclature and classification of atrial fibrillation: a collaborative project of the Working Group on Arrhythmias and the Working Group on Cardiac Pacing of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology.
      In all the different forms, electrical remodelling occurs. This remodelling further increases ectopic-triggered activity and provides an electrical substrate even more prone to re-entry formation—the 2 main arrhythmogenic mechanisms in AF—thereby facilitating the occurrence and maintenance of AF, as well described in the term “AF begets AF” by the Allessie group in 1995.
      • Wijffels M.C.
      • Kirchhof C.J.
      • Dorland R.
      • Allessie M.A.
      Atrial fibrillation begets atrial fibrillation: a study in awake chronically instrumented goats.
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      Linked Article

      • Differential sodium current remodeling identifies distinct cellular pro-arrhythmic mechanisms in paroxysmal versus persistent atrial fibrillation
        Canadian Journal of Cardiology
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          The cellular mechanisms underlying progression from paroxysmal to persistent atrial fibrillation (AF) are not fully understood, but alterations in (late) sodium current (INa) have been proposed. Human studies investigating electrophysiological changes at the paroxysmal stage of AF are sparse, with the majority employing right atrial appendage cardiomyocytes (CMs). We here investigated action potential (AP) characteristics and (late) INa remodeling in left atrial appendage CMs (LAA-CMs) from patients with paroxysmal and persistent AF and patients in sinus rhythm (SR), as well as the potential contribution of the “neuronal” sodium channel SCN10A/NaV1.8.
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